Rates and predictors of hospital and emergency department care after catheter ablation of atrial fibrillation. (28th February 2023)

• Record Type: Journal Article
• Authors: Friedman, Daniel J.; Freeman, James V.; Wong, Charlene; Febre, Janice; Iglesias, Maximiliano; Khanna, Rahul; Piccini, Jonathan P.
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 34:Number 4(2023)
• Page Start: 823
• Page End: 830
• Publication Date: 2023-02-28
• Subjects: atrial fibrillation -- catheter ablation -- database -- hospitalization; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.15841
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Introduction: Although atrial fibrillation (AF) ablation has become increasingly safer, rehospitalization and emergency department (ED) evaluations can occur in the postablation period. Better understanding of the frequency, causes, and predictors for hospitalization and ED evaluation after ablation are needed, particularly as same‐day discharge programs expand. Methods: The Optum Clinformatics database was used to define rates, causes, and predictors of hospital and ED care after AF ablation performed between January 2016 and May 2019. Primary outcomes were all‐cause hospital and ED care within 30 days of discharge. Independent predictors of all‐cause ED and hospital admissions care were determined via logistic regression. Results: Of the 18 848 patients in this study, the mean age was 67.5 ± 10 years, 37.9% were female, and the mean CHA2 DS2 ‐VASc score was 3.27 ± 1.84. Within 30 days of AF ablation, 1440 of 18 848 patients (7.6%) required hospital care of which 15% had >1 admission; 7.9% required ED care of which 28.6% had >1 ED visit. The most common reasons for hospital admission (which occurred on average 12.3 days after discharge) were supraventricular tachycardia (SVT) or AF (33.2%), heart failure (12.7%), and infection (12.2%). The most common reasons for ED care were SVT/AF (15.0%), noncardiac chest pain (13.3%), and noninfectious respiratory illness (12.2%). Age, female sex, ablation in an inpatient setting, and co‐morbidities were associated with increased risk of rehospitalization. Age, female sex, patient comorbidities, and non‐use of direct oral anticoagulation were associated with increased risk of ED visit. Conclusion: Approximately 7%–8% of patients require unplanned hospitalization or ED care after AF ablation, most commonly due to SVT/AF. Predictors of unscheduled care include patient age, sex, and several patient comorbidities. This study can inform quality improvement initiatives by identifying common causes for unscheduled care. Abstract : Cumulative and daily rate of ER visits and hospitalizations over the 30 days after discharge from atrial fibrillation ablation. Horizontal bar graphs depict the 10 most frequent reasons for ER visits and rehospitalizations. The tables list the risk factors for unscheduled care.