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Equity of Access and Outcomes: A Comparison Between In-Area and Out-of-Area Patients Undergoing Ventricular
Ashish Sood1, Samual Turnbull1, Kasun De Silva1
1Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, The University of Sydney, Sydney, NSW, Australia.
Insights
Out-of-area (OOA) patients undergoing ventricular arrhythmia (VA) ablation at high-volume centers experience similar wait times and outcomes as in-area patients. This study indicates geographic location does not disadvantage patients seeking expert VA ablation care.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Outcomes
Background:
- High-volume centers improve patient outcomes for ventricular arrhythmia (VA) ablation.
- The impact of expert center concentration on out-of-area (OOA) patients requires investigation.
Purpose of the Study:
- To compare in-area (IA) and OOA patients undergoing VA ablation at an expert referral center.
- To assess differences in wait times for consultation and ablation.
- To evaluate long-term outcomes including VT recurrence and mortality for non-PVC ablations.
Main Methods:
- Retrospective analysis of 280 VA ablation cases (2017-2021).
- Comparison of IA and OOA patient cohorts.
- Analysis of time from referral to consultation and ablation.
- Assessment of VT recurrence and composite outcomes for non-PVC ablations.
Main Results:
- 42.1% of cases were OOA referrals.
- No significant difference in time from referral to consultation or ablation between IA and OOA patients.
- Similar rates of VT recurrence and composite outcomes (death/transplant) for non-PVC ablations between IA and OOA patients.
Conclusions:
- OOA patients referred for VA ablation at this urban tertiary center are not disadvantaged.
- Wait times for consultation and ablation are comparable for IA and OOA patients.
- Long-term outcomes are similar for IA and OOA patients undergoing VA ablation.
Background:
Improved patient outcomes after ventricular arrhythmia (VA) ablation procedure have been found to correlate with procedures being performed in high volume centres. Whether the concentration of expertise in experienced, urban centres disadvantages out-of-area (OOA) patients requires investigation.
Methods:
We retrospectively analysed 280 patients undergoing catheter ablation for VAs between 2017 and 2021 at an expert referral centre for VA ablation. In-area (IA) and OOA cases were compared for differences in time from referral to electrophysiologist consultation and ablation procedure. For the subset of patients undergoing catheter ablation for non-premature ventricular complex (PVC) ablation, differences in rates of ventricular tachycardia (VT) recurrence and a composite outcome of VT recurrence, cardiac transplantation or death were also compared.
Results:
One hundred and eighteen (42.1%) cases during the study period were OOA referrals. The median time from referral to consultation was 0 days (interquartile range [IQR] 0-12), and from referral to ablation was 10 days (IQR 3-87); with no significant difference between IA and OOA patients with regards to timing of ablation (p=0.86 and p=0.32 respectively). IA and OOA patients undergoing non-PVC ablations had similar rates of VT recurrence (34.7% vs. 35.7%, p=0.89) and the composite endpoint (48.3% vs. 44.0%, p=0.55).
Conclusion:
For patients referred to undergo VA ablation at our urban tertiary centre, OOA patients are not disadvantaged compared to IA patients in terms of time to consultation and/or ablation, or long-term outcomes.
