Effect of Ablation for Atrial Fibrillation on Heart Failure Readmission Rates

Atrial fibrillation (AF) and heart failure (HF) cause numerous hospital admissions. We investigated if AF increases readmissions in patients with HF and whether AF ablation alters readmissions for HF exacerbations. The 2013 Nationwide Readmissions Database was analyzed for all-cause 90-day readmissions, after discharge for HF exacerbation. Kaplan-Meier analysis was used to compare hazard rates for readmissions due to HF exacerbation, after recent ablation versus no ablation. There were 885,270 admissions for HF exacerbation of which 364,447 had coexisting AF. All-cause 90-day readmission rates were higher in patients with HF with coexisting AF versus those without AF (41.4% vs 37.6%, p <0.0001). Associated factors increasing all-cause 90-day readmissions after ablation in patients without HF were female (odds ratio [OR] 1.44, p <0.001), complication of ablation (OR 1.44, p = 0.022), coronary artery disease (OR 1.56, p <0.001), chronic lung disease (OR 1.74, p <0.001), and malnutrition (OR 10.33, p <0.001). These factors were not significant for patients with HF. HF was not a significant risk factor for complications of ablation (adjusted OR 0.82, 95% confidence interval 0.57 to 1.18). Patients who underwent ablation versus patients who were discharged after HF exacerbation without ablation had a lower rate and length of stay for the 90-day readmission episode, due to HF exacerbation (27.5% vs 41.4%, p <0.0001, and 5.58 days vs 6.60 days, p = 0.031, respectively). In conclusion, AF increased 90-day readmissions in patients with HF, and ablation for AF in patients with HF was associated with reduced frequency, length of stay, and readmissions without an increase in complication rates.