Introduction:
Data on the utilization and economic outcomes of catheter ablation in atrial fibrillation (AF) is scarce, limiting the ability to make informed policy decisions.
Hypothesis:
We hypothesized that the number of catheter ablations for AF increased while length of stay and charges decreased.
Methods:
Patients > 18 years undergoing catheter ablation for AF were selected in the 2003-2008 HCUP-Nationwide Inpatient Sample, the largest all-payor inpatient database in the US. Patient demographic and clinical variables, including a Charlson comorbidity index, as well as hospital characteristics were analyzed. We calculated trends in rates of utilization, economic (mean LOS and total inflation-adjusted charges) and clinical (in-hospital mortality and in-hospital complications, defined using ICD-9 codes) outcomes using χ
2
, Mantel-Haenszel tests, and analysis of variance (ANOVA).
Results:
There were 40,145 admissions for catheter ablation for AF (mean age 60.01 years (SD 11.74; Range 18-98). The number of ablations increased by nearly 300% between 2003 and 2008 (Table). A comparison of use rates between 2003-2005 (early) vs 2006-2008 (late) showed a higher utilization among patients aged 65-79 (27.3% vs 34.0%), those with moderate comorbidities (30.3% vs 46.3%), and medium-sized hospitals (9.8% vs 19.7%), all p<0.001. During the study period, the mean LOS decreased by 30% while inflation-adjusted charges increased by 25% (Table). There was no significant change in clinical outcomes (Table).
Conclusions:
The number of catheter ablations for AF has increased rapidly. Although the procedure is being applied to a broader patient population and being performed in smaller-sized hospitals, LOS has decreased and clinical outcomes are stable. Factors contributing to and strategies to limit rising charges for this expanding procedure are important areas of future research.
PCV10 Medical And Economic Outcomes in Patients Treated with Diltiazem or Digoxin for Atrial Fibrillation: A Database Analysis
