Abstract
Background:
Although atrial fibrillation (AF) ablation has become increasingly safer, rehospitalization and emergency department (ED) evaluations can occur in the post-ablation 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 CHA2DS2-VASc score was 3.27±1.84. Within 30 days of AF ablation, 1,440 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%), non-cardiac chest pain (13.3%), and non-infectious respiratory illness (12.2%). Female sex, ablation in an inpatient setting, insurance type, and co-morbidities were associated with increased risk of rehospitalization. Female sex, insurance type, 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 sex and several patient comorbidities. This study can inform quality improvement initiatives by identifying common causes for unscheduled care.
INTRODUCTION
Catheter ablation is an increasingly common treatment for rhythm control of paroxysmal and persistent forms of atrial fibrillation (AF). Although AF ablation has become increasingly safe, often allowing for same day discharge, delayed procedural complications can occur and can require unscheduled care in the emergency department (ED) and inpatient setting. While several published studies have described 30-day readmission rates of 10% or more1–4 and one study reported a 30-day rate of ED visits of nearly 20%,2 these reports all rely on data from 2014 or earlier. While death within the 30 days after AF ablation is relatively infrequent, over half of all deaths within this time occur during a readmission.5 Given the impact of unscheduled care after AF ablation on patient quality of life, health, healthcare costs, and potentially mortality, we performed a detailed assessment of contemporary rates and predictors of ED and hospital admission within the 30 days after AF catheter ablation.
METHODS
Data Source
The Optum Clinformatics database, which is an administrative claims database comprised of healthcare claims of beneficiaries with UnitedHealth private insurance and Medicare Advantage programs, was used for study purposes. This database contains de-identified data derived from health plan members’ enrollment data and facility, physician, and pharmacy claims.6, 7
Study Sample
Patients aged ≥18 years who underwent a catheter ablation procedure for AF (International Classification of Diseases, 10th Revision, Clinical Modification [ICD-10-CM] codes: I48.0, I48.2, I48.91, I48.1) between January 1, 2016 and May 30, 2019 were considered. For inpatient ablation procedures (ICD-10 procedure codes: 02553ZZ, 02563ZZ, 02573ZZ, 02583ZZ, 025K3ZZ, 025L3ZZ, 025M3ZZ, 025S3ZZ, 025T3ZZ), a primary diagnosis of AF was required. For outpatient ablation (CPT 93656), AF could be a primary or secondary diagnosis. The first such ablation procedure was considered the “index ablation”. Patients were required to be continuously enrolled in their insurance plan for 12 months before the index ablation to allow for determination of baseline comorbidities. Patients were excluded if, during the 12 months prior to the index ablation, they 1) underwent ablation for primary or secondary diagnosis of AF, 2) had a coronary artery bypass grafting, surgical ablation, a valvular procedure, or left atrial appendage closure procedure or 3) were diagnosed with congenital heart disease.
Study Covariates
Study covariates included baseline patient demographics (age, sex), setting of index ablation (inpatient versus outpatient), intracardiac echocardiography use during the index procedure, and patient comorbidities including pacemaker or implantable cardioverter-defibrillator, sleep apnea, obesity, diabetes, hypertension, chronic pulmonary disease, renal disease, other non-AF arrhythmias, valvular disease, coronary artery disease, myocardial infarction, peripheral vascular disease, stroke or transient ischemic attack, and heart failure. The Charleston Comorbidity Index (CCI) was calculated as previously reported.8 Prescription drug use was determined according to the National Drug Code (NDC) directory (anti-arrhythmic drugs including amiodarone, dofetilide, flecainide, propafenone, ibutilide, sotalol, dronedarone, quinidine, and disopyramide; anti-coagulants including warfarin; diuretics); complete outpatient prescription fill data was available for all patients. Definitions for all study covariates are listed in the Supplementary table.
Outcomes
The primary outcomes of interest were all-cause hospitalization and all-cause ED visit within 30 days of discharge from the index ablation. “Hospitalizations” included observation and inpatient hospitalizations. Hospitalization and ED visit were differentiated using ‘place of service’ values indicating inpatient facility and ED, respectively. If an ED visit resulted in a hospitalization, the episode of care was considered to be a hospitalization. Reasons for hospitalization and ED visits were evaluated using ICD-10-CM primary diagnosis codes and grouped into similar disease categories (Supplementary table). Due to limited granularity of billing claims, SVT and AF were combined into a single category (SVT/AF) which also included atrial flutter. Average time to hospitalization was calculated by subtracting the date of first hospitalization from the index ablation discharge date.
Statistical Analysis
Descriptive statistics were reported for study factors. Multicollinearity between study covariates was assessed, with correlation above 0.6 or higher considered as strong. Univariate analyses were conducted to examine the relationship between primary causes of hospitalization/ED visit and study covariates; covariates that emerged significant (p<0.05) were included in the multivariate analysis. Stepwise multivariable logistic regression analyses with a backward elimination (criteria for elimination was p<0.05) was performed to identify predictors of all-cause hospitalization and all-cause ED visits within 30-days of the index ablation procedure. Weighted risks scores were developed using the parameter estimates of significant multivariable predictors of the outcome of interest. Factors associated with higher risk were assigned positive point values and factors associated with lower risk were assigned negative point values.9 Point scores were derived by dividing the parameter estimate by 0.05 and rounding to the nearest 0.5. The odds ratios, 95% confidence intervals, and p-values for predictors were reported with statistical significance set at p<0.05 or 95% confidence intervals excluding 1. The area under the receiver operating characteristic curve (C-statistic) was used to examine the level of model discrimination for the prediction models for hospitalization and ED evaluation.
RESULTS
Between January 1, 2016, and May 30, 2019, a total of 25,777 patients in the study database underwent catheter ablation for AF. After applying study exclusions, a total of 18,848 patients were available for analysis. See Supplemental Figure 1 for a detailed description of exclusions.
The mean age of the study population was 67.5 years (±10.0), 37.9% were women, and the median CHA2DS2-VASc score was 3.0 (interquartile range [IQR] 2.0, 4.0). The proportion of patients with CHA2DS2-VASc score ≥3 was 63.8% of patients, the proportion of patients with CCI score ≥2 was 54.6%. Frequently observed comorbidities included sleep apnea (35.8%), heart failure (36.3%), obesity (32.3%), diabetes (27.5%), hypertension (81.2%), CAD (43.4%), chronic pulmonary disease (27.1%), and valvular disease (44.2%).
Within the 30 days after discharge, there were 1,703 readmissions among 1,440 patients (7.6% of all patients); 15% of these patients had multiple readmissions. The average time from hospital discharge to readmission was 12.3 days. The most common causes of readmission (Central Illustration) included supraventricular arrhythmia including AF (33.2%), heart failure (12.7%), and infection (12.2%). Notably but relatively infrequent causes for admission included ischemic stroke (1.5%), intracranial bleed (0.7%), pericardial effusion (1.4%), and pericardial tamponade (0.1%). Table 2 provides a detailed summary of the 10 most common reasons for hospital readmission.
Central Illustration.
Cumulative and daily rate of ER visits and hospitalizations over the 30 days after discharge from AF ablation. Horizontal bar graphs depict the 10 most frequent reasons for ER visits and rehospitalizations. The tables list the risk factors for unscheduled care.
Table 2.
The most common causes for 30-day hospital readmission among 18,848 patients undergoing AF ablation
| Rank | Category | # of Readmission (episode-level) | % of Readmission (episode-level) | # of patients with Readmission (patient-level) | % of Total (patient-level) | Average Days to Readmission |
|---|---|---|---|---|---|---|
| - | All-cause | 1,703 | 100.0% | 1,440 | 7.6% | 12.3 |
| 1 | SVT including AF | 565 | 33.2% | 539 | 2.9% | 8.9 |
| 2 | Heart failure | 216 | 12.7% | 200 | 1.1% | 10.7 |
| 3 | Infection | 207 | 12.2% | 191 | 1.0% | 12.3 |
| 4 | Respiratory, non-infectious | 90 | 5.3% | 82 | 0.4% | 11.7 |
| 5 | Cardiac, unrelated to arrhythmia, HF, MI | 50 | 2.9% | 47 | 0.2% | 11.7 |
| 6 | Genitourinary | 48 | 2.8% | 42 | 0.2% | 12.2 |
| 7 | GI, non-hemorrhagic | 46 | 2.7% | 43 | 0.2% | 12.1 |
| 8 | Bradycardia | 45 | 2.6% | 44 | 0.2% | 9.0 |
| 9 | Bleeding | 41 | 2.4% | 40 | 0.2% | 5.5 |
| 10 | Pericardial disease* | 38 | 2.2% | 38 | 0.2% | 8.3 |
AF = atrial fibrillation, GI = gastrointestinal, HF = heart failure, MI = myocardial infarction, SVT = supraventricular tachycardia
Not related to pericardial effusion with or without tamponade
Within the 30 days of discharge from the catheter ablation procedure, there were a total of 3,041 ED visits (that did not result in hospital admission) among 1,490 patients (7.9%); 28.6% of these patients had multiple ED visits. The average time from hospital discharge to ED visit was 12.6 days. The most common causes for ED evaluation (Central Illustration) include supraventricular arrhythmia including AF (15.0%), chest pain (13.3%), noninfectious respiratory complaints (12.0%), and musculoskeletal complaints (10.8%). Table 3 provides a detailed summary of the 10 most common reasons for ED evaluation.
Table 3.
The most common causes for 30-day ED evaluation among 18,848 patients undergoing AF ablation
| Rank | Category | # of ER visits (episode-level) | % of ER visits (episode-level) | # of patients with ER visit (patient-level) | % of Total (patient-level) | Average days to ER visit |
|---|---|---|---|---|---|---|
| - | All-cause | 3,041 | 100.0% | 1,490 | 7.9% | 12.6 |
| 1 | SVT including AF | 457 | 15.0% | 367 | 1.9% | 13.1 |
| 2 | Chest pain, other | 403 | 13.3% | 329 | 1.7% | 13.0 |
| 3 | Respiratory, non-infectious | 367 | 12.1% | 318 | 1.7% | 12.0 |
| 4 | Musculoskeletal | 329 | 10.8% | 241 | 1.3% | 20.4 |
| 5 | GI, non-hemorrhagic | 158 | 5.2% | 141 | 0.7% | 12.5 |
| 6 | Other | 152 | 5.0% | 144 | 0.8% | 11.3 |
| 7 | Trauma | 150 | 4.9% | 135 | 0.7% | 14.7 |
| 8 | Infection | 143 | 4.7% | 129 | 0.7% | 10.6 |
| 9 | Cardiac, unrelated to arrhythmia, HF, MI | 140 | 4.6% | 125 | 0.7% | 12.7 |
| 10 | Genitourinary | 112 | 3.7% | 97 | 0.5% | 12.2 |
AF = atrial fibrillation, GI = gastrointestinal, HF = heart failure, MI = myocardial infarction, SVT = supraventricular tachycardia
Characteristics associated with increased risk of 30-day readmission (Table 4) include Age ≥65 years (OR 1.231. CI 1.076–1.408, p=0.0024) female sex (OR 1.371, CI 1.222–1.539, p<.0001), ablation in the inpatient setting (OR 2.064, CI 1.818–2.344, p<.0001), diuretic use (OR 1.170, CI 1.032–1.326, p=0.0140), heart failure (OR 1.243, CI 1.094–1.412, p=0.0008), pacemaker or ICD (OR 1.310, CI 1.129–1.520, p=0.0004), renal disease (OR 1.226, CI 1.067–1.409, p=0.0040), diabetes (OR 1.277, CI 1.130–1.442, p<.0001), hypertension (OR 1.463, CI 1.204–1.778, p<0.0001), chronic pulmonary disease (OR 1.329, CI 1.179–1.498, p<.0001), coronary artery disease (OR 1.212, CI 1.075–1.366, p=0.0017), and stroke or TIA (OR1.174, CI 1.023–1.347, p=0.0226 ). The area under the curve for the adjusted model was 0.6730.
Table 4.
Independent predictors of 30-day rehospitalization after AF ablation
| Characteristic | Odds ratio | 95% CI | P-value | |
|---|---|---|---|---|
| Age ≥65 years (vs. <65 years) | 1.231 | 1.076 | 1.408 | 0.0024 |
| Female (vs. male) | 1.371 | 1.222 | 1.539 | <.0001 |
| Inpatient setting (vs. outpatient setting) | 2.064 | 1.818 | 2.344 | <.0001 |
| Diuretic use | 1.170 | 1.032 | 1.326 | 0.0140 |
| Heart Failure | 1.243 | 1.094 | 1.412 | 0.0008 |
| Pacemaker or ICD | 1.310 | 1.129 | 1.520 | 0.0004 |
| Renal disease | 1.226 | 1.067 | 1.409 | 0.0040 |
| Diabetes | 1.277 | 1.130 | 1.442 | <.0001 |
| Hypertension | 1.463 | 1.204 | 1.778 | 0.0001 |
| Chronic pulmonary disease | 1.329 | 1.179 | 1.498 | <.0001 |
| Coronary artery disease | 1.212 | 1.075 | 1.366 | 0.0017 |
| Stroke/Transient ischemic attack | 1.174 | 1.023 | 1.347 | 0.0226 |
AF = atrial fibrillation, CI = confidence interval, ICD = implantable cardioverter defibrillator
Multivariable logistic regression model adjusted for age, sex, setting of index ablation, intracardiac echocardiography use during the index procedure, pacemaker or implantable cardioverter-defibrillator, sleep apnea, obesity, diabetes, hypertension, chronic pulmonary disease, renal disease, other non-AF arrhythmias, valvular disease, coronary artery disease, myocardial infarction, peripheral vascular disease, stroke or transient ischemic attack, heart failure and prescription drug use.
Characteristics associated with increased risk of 30-day ED visit (Table 5) include age ≥65 years (OR 1.671, CI 1.456–1.918, p<.0001), female sex (OR 1.313, CI 1.175–1.469, p<.0001), other arrhythmia (OR 1.199, CI 1.039–1.384, p=0.0131 ), renal disease (OR 1.194, CI 1.041–1.370, p=0.0114), diabetes (OR 1.179, CI 1.045–1.330, p=0.0075), hypertension (OR 1.240, CI 1.046–1.470, p=0.0132), chronic pulmonary disease (OR 1.227, CI 1.091–1.380, p=0.0006), coronary artery disease (OR 1.226, CI 1.093–1.375, p=0.0005), stroke or TIA (OR 1.198, CI 1.046–1.372, p = 0.0089). DOAC use (versus no anticoagulation, OR 0.782, CI 0.689–0.887, p=0.0001) was associated with a lower risk of ED visit. The area under the curve for the adjusted model was 0.6257.
Table 5.
Independent predictors of 30-day ED visit after AF ablation
| Characteristic | Odds ratio | 95% CI | P-value | |
|---|---|---|---|---|
| Age ≥65 years (vs. <65 years) | 1.671 | 1.456 | 1.918 | <.0001 |
| Female (vs. male) | 1.313 | 1.175 | 1.469 | <.0001 |
| DOAC (vs. no anticoagulation) | 0.782 | 0.689 | 0.887 | 0.0001 |
| Other arrhythmia including atrial flutter | 1.199 | 1.039 | 1.384 | 0.0131 |
| Renal disease | 1.194 | 1.041 | 1.370 | 0.0114 |
| Diabetes | 1.179 | 1.045 | 1.330 | 0.0075 |
| Hypertension | 1.240 | 1.046 | 1.470 | 0.0132 |
| Chronic pulmonary disease | 1.227 | 1.091 | 1.380 | 0.0006 |
| Coronary artery disease | 1.226 | 1.093 | 1.375 | 0.0005 |
| Stroke/Transient ischemic attack | 1.198 | 1.046 | 1.372 | 0.0089 |
AF = atrial fibrillation, CI = confidence interval, DOAC = direct oral anticoagulant, ED = emergency department
Multivariable logistic regression model adjusted for age, sex, diabetes, hypertension, chronic pulmonary disease, renal disease, other non-AF arrhythmias, coronary artery disease, myocardial infarction, peripheral vascular disease, stroke or transient ischemic attack, and prescription drug use.
Separate risk scores were created for the prediction of unscheduled care in the ED and inpatient settings within 30 days of an AF ablation (Figure 3). The relationship between the calculated risk score and the observed incidence of unscheduled care was linear (re-hospitalization: y = 0.5258x - 2.9893 and ED care: y = 0.3135x + 2.7611 where x is the calculated risk score and y is the incidence of unscheduled care. A risk score of <10 (calculated using appropriate score) was associated with low rates of ED care (3.7%) and re-hospitalization (2.9%) which risk scores of ≥30 was associated with elevated rates of ED care (13.4%) and re-hospitalization (14.0%)
Figure 3.
Use of a risk score for prediction of (a) all-cause hospital readmission or (b) all-cause ED visit within the 30 days of discharge after an AF ablation. Risk factors and associated points are depicted in the tables at the bottom of the figure. The relationship between calculated risk score (x axis) and observed incidence of unscheduled care (y axis) is visually depicted for both outcomes.
DISCUSSION
This study, which defines rates, causes, and predictors of unscheduled care in the ED and inpatient settings within 30 days of an AF ablation, has several clinically relevant findings. First, we report that in the contemporary era, 30-day readmission rates are approximately 8%, and the most common causes are SVT including AF, heart failure, and infection with a mean time to rehospitalization of 12 days. Second, we report that approximately 8% of patients have 1 or more ED visit during the 30 days after AF ablation, and the most common causes are SVT including AF, chest pain, and non-infectious respiratory complaints. Predictors of both hospital re-admission and ED care include age, female sex, diabetes, hypertension, chronic lung disease, coronary artery disease, and stroke or transient ischemic attack. Predictors of hospital re-admission include heart failure, diuretic use, and AF ablation in the inpatient setting. DOAC use was associated with a lower rate of ED care. The results from this study (Central Illustration) can inform quality improvement initiatives aimed at preventing acute illness in the post-ablation period.
While existing studies of unscheduled care after AF ablation provide important context for our study, common limitations across studies include use of non-contemporary datasets and in most instances an absence of data regarding ED usage. In a study of Medicare enrollees undergoing catheter ablation from 2007–2009, the 30-day readmission rate was 12.3%.4 An analysis of 2014 AF ablations from the multi-payor US Nationwide Readmissions Database, which is limited to inpatient encounters only, reported a 30-day readmission rate of 11%.3 Cheung and colleagues evaluated 30-day readmissions after AF ablation performed from 2010–2014 using the US Nationwide Readmissions Database and similarly reported a rate of 10.9%.1 Both analyses from the NRD identified arrhythmias (including AF) and heart failure as the two most common causes for readmission. An analysis of two Kaiser healthcare systems demonstrated 9.7% of patients were hospitalized within the 30 days of an AF ablation and 19.1% of patients had an ED visit during that same interval.2 Our analysis, which studied AF ablations performed during a more contemporary time period (2016 through May 2019), reported the lowest rate of 30-day rehospitalizations to date (7.6%) and a 30 day ED visit rate of 7.9%, much lower than what was reported in the Kaiser database analysis. While some of these differences may be related to differences in patient populations across these studies, overall rates of rehospitalization appear to be stable or decreasing with time and the lower rates of readmission aren’t simply due to a shifting of unscheduled care from the inpatient to ED setting. Factors including improvements in periprocedural management, catheter ablation technology, and mapping and imaging technology may contribute to the lower rates of readmission as seen in our study as compared to previous literature. However, rates of rehospitalization and ED evaluation remain substantial, representing a target for future research and quality improvement initiatives.
It is remarkable that the most common cause for hospital readmission and ED care is precisely the disease process we aim to treat with catheter ablation. There are likely several mechanisms underpinning this finding, including early pulmonary vein reconnections, post-ablation antiarrhythmic drug discontinuation, and inflammation related pro-arrhythmia, even in the absence of overt pericarditis. Antiarrhythmic drug continuation during the blanking period10, 11 and increased use of anti-inflammatory therapies (e.g. colchicine12) could significantly reduce early readmissions and ED visits for recurrent atrial arrhythmias. These data emphasize that while recurrences early in the blanking period may have attenuated long term prognostic value, they can have a substantial impact on quality of life and healthcare utilization in the short to medium term after ablation.
Heart failure hospitalizations remain common after AF ablation, largely related to the baseline burden of HF in an AF ablation population, as well as the intraprocedural fluid administration required to achieve sufficient catheter irrigation. Encouragingly, the average of 10.7 days between discharge and heart failure readmissions suggests there may be an adequate window of time during which to intervene with diuretic therapy and a target for quality improvement initiatives. Post-ablation follow-up programs, including close monitoring for weight changes and heart failure symptoms, have the potential to make a meaningful impact.
Overall, the predictive models for inpatient admission and ED visits demonstrated modest predictive value, with c-statistics of 0.6730 and 0.6257, respectively. Patient comorbidities were risk factors for both outcomes. The strongest predictor of repeat inpatient admission was ablation during an inpatient admission; this variable identifies patient who were either admitted for an acute medical issue and underwent catheter ablation and patients who were scheduled for an outpatient ablation but experienced post-operative complications that justified billing for an “inpatient” stay.
Limitations
This is a retrospective analysis of administrative claims data with several well-known limitations, including absence of certain procedure characteristics (e.g. ablation catheter type). Billing claims may be less accurate than endpoints formally adjudicated in a clinical trial. This study was limited to patients with certain insurance carriers and results may not be generalizable to other insurance carriers (e.g. fee-for-service Medicare). Although the endpoints in this study are in close temporal proximity to a catheter ablation procedure, we are unable to assess whether the procedure itself and an episode of unscheduled care is causally related. Although we performed adjusted models to assess the relationship between patient characteristics and unscheduled care, some amount of residual confounding is likely.
CONCLUSIONS
In an analysis of a large contemporary cohort of patients undergoing AF ablation, 30-day rates of hospital readmission and ED visit were 7.6% and 7.9%, respectively. These rates were lower compared to previous reports and may reflect improvements in ablation technology and periprocedural care strategies, although rates remain substantial and a target for future research and quality improvement initiatives. Patient sex, co-morbidities, and other factors demonstrated a modest ability to predict unscheduled care. The average time between discharge and rehospitalization was greater than 7 for most diagnoses, suggesting that early detection of clinical decline after discharge from the index hospitalization is essential.
Supplementary Material
Figure 1.
Independent predictors of all-cause hospital readmission within the 30 days of discharge after an AF ablation.
Figure 2.
Independent predictors of all-cause ED visit within the 30 days of discharge after an AF ablation.
Table 1.
Baseline characteristics of the 18,848 patients who underwent AF ablation
| N | Percent | |
|---|---|---|
| Age | ||
| <65 years | 6,215 | 33.0% |
| ≥65 years | 12,633 | 67.0% |
| Sex | ||
| Female | 7,136 | 37.9% |
| Male | 11,712 | 62.1% |
| Insurance Type | ||
| Other/Indemnity | 9,121 | 48.4% |
| EPO/PPO | 1,988 | 10.5% |
| HMO | 2,717 | 14.4% |
| POS | 5,022 | 26.6% |
| Place of service | ||
| Inpatient | 2,933 | 15.6% |
| Outpatient | 15,915 | 84.4% |
| Antiarrhythmic drug use* | 11,472 | 60.9% |
| Diuretic use* | 6,085 | 32.3% |
| Anticoagulant* | ||
| None | 4,643 | 24.6% |
| DOAC | 11,328 | 60.1% |
| Warfarin | 2,877 | 15.3% |
| Sleep Apnea | 6,741 | 35.8% |
| Heart Failure | 6,846 | 36.3% |
| Cardiomyopathy | 3,693 | 19.6% |
| Other arrhythmia | 14,939 | 79.3% |
| Pacemaker or ICD | 2,400 | 12.7% |
| Renal Disease | 3,106 | 16.5% |
| Obesity | 6,095 | 32.3% |
| Diabetes | 5,190 | 27.5% |
| Hypertension | 15,299 | 81.2% |
| Chronic Pulmonary Disease | 5,103 | 27.1% |
| Coronary Artery Disease | 8,178 | 43.4% |
| Myocardial Infarction | 2,195 | 11.6% |
| Valvular Disease | 8,325 | 44.2% |
| Peripheral vascular disease | 3613 | 19.2% |
| Stroke/Transient ischemic attack | 3,121 | 16.6% |
| Intracardiac echocardiography | 16,943 | 89.9% |
| CHA2DS2-VASC | ||
| <3 | 6828 | 36.2% |
| ≥3 | 12020 | 63.8% |
| CCI Score | ||
| 0 | 4477 | 23.8% |
| 1 | 4083 | 21.7% |
| ≥2 | 10288 | 54.6% |
CCI = Charleston Comorbidity Index, DOAC = direct oral anticoagulant, EPO = Exclusive provider organization, HMO = Health Maintenance Organization, IND = Indemnity, ICD = implantable cardioverter defibrillator, OTH = Other, POS = Point of Service, PPO = Preferred provider organization
within the 12 months prior to the index ablation
Funding:
Funding for this analysis was provided by Johnson and Johnson
Footnotes
Disclosures: Dr. Freeman has received salary support from the American College of Cardiology NCDR and the National Heart, Lung, and Blood Institute; has received consulting/Advisory Board fees (modest) from Boston Scientific, Medtronic, Janssen Pharmaceuticals, PaceMate, and Biosense Webster; and has equity in PaceMate. Dr. Friedman has received: research support from American Heart Association, Boston Scientific, Biosense Webster, Merit Medical, and Abbott and consulting fees from Abbott, AtriCure, and Sanofi. Dr. Piccini is supported by R01AG074185 from the National Institutes of Aging. He also receives grants for clinical research from Abbott, the American Heart Association, the Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, iRhythm, and Philips and serves as a consultant to Abbott, Abbvie, Bayer, Biotronik, Boston Scientific, Bristol Myers Squibb, Element Science, Itamar Medical, LivaNova, Medtronic, Milestone, ElectroPhysiology Frontiers, ReCor, Sanofi, Philips, and Up-to-Date.Dr. Khanna, Ms Wong, and Mr. Iglesias are employees of Johnson and Johnson. Ms. Febre reports no disclosures.
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