Thirty‐day readmissions after atrial fibrillation catheter ablation in patients with heart failure

Abstract

Background Randomized clinical trial data have demonstrated catheter ablation (CA) as a viable treatment modality for atrial fibrillation (AF). Patients with heart failure (HF) undergoing AF CA appear to derive improvements in quality of life and mortality compared to those treated with medical therapy (MT). Contemporary national data on 30‐day readmissions after CA compared to MT among patients with HF are lacking. Methods From the 2016 Nationwide Readmissions Databases, 749 776 (weighted national estimate: 1 421 673) AF HF patients were identified of which 2204 (0.3%) underwent CA and 747 572 (99.7%) received MT. Propensity matching balanced baseline clinical characteristics. Thirty‐day readmission rates, causes, predictors, and costs of 30‐day readmission were compared. Results Among both the unmatched and matched cohorts, 30‐day readmissions were lower for patients treated with CA compared to MT (16.8% vs 20.1%, P < .001 and 16.8% vs 18.8%, P = .020). CA was associated with reduced risk of readmission compared to MT (odds ratio 0.86, 95% confidence interval [CI]: 0.77‐0.97). HF exacerbation and arrhythmias were the most common cause for 30‐day readmission after CA. CA costs were higher during index hospitalization but similar to MT during readmission among the matched cohort ($15 858 ± $21 636 vs $16 505 ± $29 171, P = .67). Predictors of readmission were largely nonmodifiable risk factors among both the CA and MT groups. Conclusions Nearly one in six patients with HF is readmitted within 30‐days after undergoing CA. In propensity matched analyses, CA was associated with decreased rate and risk for readmission compared to MT. CA has higher index hospitalization costs, but lower readmission costs.

Improved survival in patients with atrial fibrillation and heart failure undergoing catheter ablation compared to medical treatment: A systematic review and meta‐analysis of randomized controlled trials

“…Lima et al recently described a significant reduction in 30-day readmissions (16.8% vs. 18.8%, p = .02) in patients with HF undergoing CA for AF compared with a propensity score matched group receiving medical therapy. 21 Importantly, although the costs of the index hospitalization were significantly higher for the CA group, after readmission, overall costs were similar between the two groups. Field et al found significant reductions in AF-related hospitalizations (64%), emergency department 22 visits (51%), and HF related hospitalizations (22%), all of which translated into a reduction in AF related costs and ED related costs.…”

“…Finally, significant cost reductions could result from AF CA in HF patients. Lima et al recently described a significant reduction in 30‐day readmissions (16.8% vs. 18.8%, p = .02) in patients with HF undergoing CA for AF compared with a propensity score matched group receiving medical therapy 21 . Importantly, although the costs of the index hospitalization were significantly higher for the CA group, after readmission, overall costs were similar between the two groups.…”

Improved Survival in Patients with Atrial Fibrillation and Heart Failure Undergoing Catheter Ablation Compared to Medical Treatment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Lima et al recently described a significant reduction in 30-day readmissions (16.8% vs 18.8%, P = 0.02) in patients with HF undergoing CA for AF compared with a propensity score matched group receiving medical therapy. 21 Importantly, although the costs of the index hospitalization were significantly higher for the CA group, after readmission, overall costs were similar between the two groups. Field et al found significant reductions in AF-related hospitalizations (64%), emergency department 22 visits (51%), and HF related hospitalizations (22%), all of which translated into a reduction in AF related costs and ED related costs.…”

Atrial fibrillation ablation in heart failure patients: Where do we stand in 2023? – State of the art review

“…In a propensity‐matched comparison of HF patients undergoing AF ablation versus those treated medically, ablation was associated with an 11% reduction in the 30‐day hospitalization rate ( p = .020) among all HF patients 73 and a reduction in the 120‐day hospitalization rate of 25.2% in HFrEF patients and 28.5% in HFpEF patients ( p < 0001), 66 resulting in a 20% RR in total hospitalization costs after ablation 66 . Similarly, in the Optum database, AF ablation was associated with a 64% reduction in AF‐related admissions, a 65% reduction in LOS, a 52% reduction in the need for cardioversions, a 51% reduction in ER visits, and a 22% reduction in HF admissions resulting in an overall 36% reduction in costs ( p < .0001) 74 …”