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California study of Ablation (CAABL):early utilization after index hospitalization for non-valvular atrial
Uma Srivatsa1, Beate Danielsen2, Ezra Amsterdam1
1Division of Cardiovascular Medicine, UC Davis.
Insights
Catheter ablation (ABL) for new onset non-valvular atrial fibrillation (NVAF) is underutilized. Earlier ABL may reduce healthcare burden, warranting further investigation into its timely application.
Area of Science:
- Cardiology
- Medical Interventions
- Health Services Research
Background:
- Catheter ablation (ABL) is recommended for symptomatic non-valvular atrial fibrillation (NVAF) refractory to medical therapy.
- ABL success is linked to arrhythmia duration before intervention.
- This study assesses early ABL utilization in new onset NVAF patients.
Purpose of the Study:
- To evaluate the early utilization of catheter ablation (ABL) for new onset non-valvular atrial fibrillation (NVAF).
- To identify factors influencing the decision to perform ABL in hospitalized NVAF patients.
Main Methods:
- Utilized de-identified administrative discharge records (2005-2011) for patients with new onset AF.
- Linked ambulatory surgery encounters for ABL within two years of initial hospitalization.
- Excluded specific conditions like other arrhythmias, AV nodal ablation, pacemakers/defibrillators, and valve disease for analysis.
Main Results:
- Only 0.81% (3,440/424,592) of new onset NVAF patients underwent ABL within two years.
- ABL patients were more likely to have a principal AF diagnosis, be aged 35-64, male, have private insurance, and be Caucasian.
- ABL patients had lower severity of illness and fewer major comorbidities compared to non-ABL patients.
Conclusions:
- Catheter ablation (ABL) shows low utilization for new onset non-valvular atrial fibrillation (NVAF) within two years of diagnosis.
- Earlier ABL adoption could potentially decrease the healthcare burden associated with NVAF.
- Further research is needed to explore the benefits of earlier ABL utilization.
Background:
Catheter ablation (ABL) for non-valvular AF (NVAF) is recommended for symptomatic patients refractory to medical therapy and its success is related to the duration of the arrhythmia prior to intervention.Our aim was to assess the early utilization and the factors that prompted ABL in patients hospitalized for new onset NVAF.
Methods:
Using de-identified administrative discharge records for hospitalizations and emergency department (ED) visits, we determined the patients who had a first-time (since 1991) health record diagnosis of AF between2005 - 2011. We linked ambulatory surgery encounters for ABL based on ICD 9 code occurring within two years of initial hospitalization. After excluding other cardiac arrhythmias, atrio-ventricular nodal ablation or pacemaker/defibrillator placement and cardiac valve disease, bivariate comparisons were made with those who did not undergo ABL.
Results:
During the study period,3,440 of 424,592 patients (0.81%) hospitalized for new onset NVAF underwent ABL. Parameters significantly (p<0.001) associated with ABL compared tonon-ABL patientsincluded: principal diagnosis of AF (55% vs 25%), age 35-64 yrs (46.1% vs. 22.4%), male (58.9% vs. 48.2%), private insurance (46.6% vs. 21.1%), Caucasian (81.0% vs.71.6%), lower frequency of ED visit < 6 months before index AF hospitalization (10.7% vs. 15.9%), lower severityofillness at time of AF diagnosis (16.5% vs. 35.6%) anda lower prevalence ofmajor comorbidities (p< 0.001).
Conclusions:
Ablation has low utilization for treatment of new onset NVAF within two years of diagnosis. Earlier utilization of ABL may reduce health care burden related to NVAF and requires further evaluation.
