scholarly journals Healthcare Utilization and Clinical Outcomes After Ablation of Atrial Fibrillation in Patients With and Without Insertable Cardiac Monitoring

2022 ◽  
Author(s):  
Moussa C. Mansour ◽  
Emily M. Gillen ◽  
Audrey Garman ◽  
Sarah C. Rosemas ◽  
Noreli Franco ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Healthcare Utilization ◽  
Cardiac Monitoring

scholarly journals Healthcare utilization and outcomes in atrial fibrillation ablation patients with and without insertable cardiac monitoring

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.C Mansour ◽  
E.M Gillen ◽  
A Garman ◽  
S Rosemas ◽  
P.D Ziegler ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Healthcare Utilization ◽  
Cardiac Monitoring ◽  
Funding Source ◽  
Detection Rates ◽  
Af Ablation ◽  
Af Recurrence ◽  
Clinic Visits

Abstract Background Atrial fibrillation (AF) is associated with increased risk of stroke and progression to heart failure, and as a result, increased mortality. Catheter ablation can reduce AF burden, potentially allowing discontinuation from anticoagulant medication in some patients. Post ablation, guidelines recommend ECG monitoring in patients discontinuing anticoagulation to monitor potential AF recurrence. Short-term ECG monitors have lower detection rates for AF recurrence, while long-term insertable cardiac monitors (ICM) increase detection rates and the opportunity to manage and treat AF, when it recurs. Whether more intensive monitoring via ICMs translates to improvements in health outcomes or reduced costs is not well understood. Purpose We examined healthcare utilization/costs and anticoagulant discontinuation following AF ablation, in patients with vs. without ICM. Methods Patients with a catheter ablation for AF between January 1, 2011 - March 31, 2018 were identified in a large U.S. administrative claims database. Patients with ICM implant within 1 year pre- or post-ablation were propensity score matched to patients without ICM, based on: demographics, comorbidities, CHAD2S2-VASc score, medication use and healthcare costs in baseline. Results A total of 691 ICM patients were identified and matched 1:3 with 2,073 non-ICM patients. Mean age was 65 years, 38% were female, and mean (SD) CHAD2S2-VASc was 2.29 (1.53). During an average follow-up from ablation discharge of 37 (19) months, ICM patients incurred fewer AF- and HF-related hospitalizations: mean 0.51 (0.91) vs. 0.62 (1.56) AF-related, p=0.018, and 0.14 (0.48) vs. 0.24 (1.30) HF-related hospitalizations per patient, p=0.00. Correspondingly, average per-patient costs for AF- and HF-related hospitalizations were lower in the ICM cohort: $13,041 ($30,831) vs. $17,140 ($55,576), p=0.016 and $3,921 ($17,865) vs. $6,746 ($33,148), p=0.005. The ICM cohort had a greater number of AF-related clinic visits during follow-up: 14.2 (13.0) vs. 10.2 (11.7) visits per patient, p<0.0001. The proportion of patients undergoing a repeat AF ablation during follow-up was higher in the ICM cohort (22.3% vs. 18.3%, P<0.0001), while the proportion with cardioversions was lower (21.0% vs. 25.1%, p=0.031). In patients indicated for anticoagulation (CHAD2S2-VASc≥2), the rate of anticoagulant discontinuation (defined as gap in coverage ≥90 days) was high in both cohorts: 89.5% and 84.6% of patients in ICM and non-ICM groups, respectively. Conclusions AF ablation patients with ICM experienced fewer AF- and HF-related hospitalizations/costs and fewer cardioversions during follow-up. The greater number of AF-related clinic visits and repeat AF ablations observed in ICM patients indicate closer management. Of note, anticoagulant discontinuation was similarly high in the non-ICM cohort despite guidelines recommending rigorous cardiac monitoring for AF recurrence in the context of discontinuation. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic

scholarly journals Comparison of Clinical Outcomes Among Patients With Atrial Fibrillation or Atrial Flutter Stratified by CHA2DS2-VASc Score

2018 ◽  
Vol 1 (4) ◽  
pp. e180941 ◽  
Author(s):  
Yu-Sheng Lin ◽  
Yung-Lung Chen ◽  
Tien-Hsing Chen ◽  
Ming-Shyan Lin ◽  
Chi-Hung Liu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Clinical Outcomes

Repeat Catheter Ablation for Recurrent Atrial Fibrillation: Electrophysiologic Findings and Clinical Outcomes

2021 ◽  
Author(s):  
Usama A. Daimee ◽  
Tauseef Akhtar ◽  
Thomas A. Boyle ◽  
Leah Jager ◽  
Armin Arbab‐Zadeh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clinical Outcomes ◽  
Recurrent Atrial Fibrillation

First clinical experience with the wearable cardiac rhythm long-term monitoring cardioskin device

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Guedeney ◽  
J Silvain ◽  
F Hidden-Lucet ◽  
C Maupain ◽  
S Dinanian ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Cardiac Rhythm ◽  
Cardiac Monitoring ◽  
Funding Source ◽  
Single Center ◽  
Long Term Monitoring ◽  
Monitoring Devices ◽  
Term Monitoring

Abstract Background There are only limited options for long-term cardiac monitoring devices readily available in clinical practice for outpatients. Holter monitoring devices are limited by the uncomfort of wires and patches, the small number of leads for analysis, the quality of recordings or the monitoring duration while insertable cardiac monitors are costly and exposed to potential local complication. Purpose To describe a single center experience with a novel wearable device for cardiac rhythm monitoring. Methods The Cardioskin™ system is a patch-free, wire-free, wearable device with rechargeable batteries that provides a high quality 15-lead electrocardiogram monitoring over 1 month (Figure 1). Data are sent using a mobile application downloaded in the patient smartphone to a central Corelab where they can be interpreted by an expert and/or the prescribing physician. An alarm signal is readily available within the Cardioskin™ device, to allow patients to indicate the presence of symptoms. In this single center retrospective registry, we provide a first report of the use of this novel device in real world practice, with indication and duration of cardiac monitoring left at the physicans “discretion”. Results From January 2019 to December 2019, the Cardioskin™ system was prescribed in 60 patients for an overall median duration of 26.5 (14–32) days. The mean age of the patients was 45±12.2 years and 24 (40%) were male. Indications for cardiac monitoring were post-Stroke, palpitation, syncope and cardiomyopathy assessment in 56%, 30%, 7% and 7% of the cases, respectively. A sustained (>30 seconds) supraventricular tachycardia was detected in 4 cases, including one case of atrial fibrillation, two case of atrial tachycardia and on case of junctional tachycardia. Unsustained ventricular tachycardia and atrial fibrillation burst were detected in another 2 cases (Figure 1). There was no reported case of skin irritation by the Cardioskin™ system or abrupt interruption of the monitoring by the patients. Conclusion The Cardioskin™ system is a novel, discreet and comfortable cardiac rhythm wearable long-term monitoring device which can be used in clinical practice for broad diagnostic indications. Figure 1. Cardioskin system Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ACTION coeur

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