Healthcare Utilization and Clinical Outcomes after Catheter Ablation of Atrial Flutter

<div><p>Atrial flutter ablation is associated with a high rate of acute procedural success and symptom improvement. The relationship between ablation and other clinical outcomes has been limited to small studies primarily conducted at academic centers. We sought to determine if catheter ablation of atrial flutter is associated with reductions in healthcare utilization, atrial fibrillation, or stroke in a large, real world population. California Healthcare Cost and Utilization Project databases were used to identify patients undergoing atrial flutter ablation between 2005 and 2009. The adjusted association between atrial flutter ablation and healthcare utilization, atrial fibrillation, or stroke was investigated using Cox proportional hazards models. Among 33,004 patients with a diagnosis of atrial flutter observed for a median of 2.1 years, 2,733 (8.2%) underwent catheter ablation. Atrial flutter ablation significantly lowered the adjusted risk of inpatient hospitalization (HR 0.88, 95% CI 0.84–0.92, p<0.001), emergency department visits (HR 0.60, 95% CI 0.54–0.65, p<0.001), and overall hospital-based healthcare utilization (HR 0.94, 95% CI 0.90–0.98, p = 0.001). Atrial flutter ablation was also associated with a statistically significant 11% reduction in the adjusted hazard of atrial fibrillation (HR 0.89, 95% CI 0.81–0.97, p = 0.01). Risk of acute stroke was not significantly reduced after ablation (HR 1.09, 95% CI 0.81–1.45, p = 0.57). In a large, real world population, atrial flutter ablation was associated with significant reductions in hospital-based healthcare utilization and a reduced risk of atrial fibrillation. These findings support the early use of catheter ablation for the treatment of atrial flutter.</p></div

Atrial Flutter Ablation Procedures by Calendar Year and Healthcare Setting.

<p>The absolute number of ablation procedures performed in an ambulatory surgery (light bar) or inpatient hospitalization (dark bar) setting is shown for each calendar year included in the study.</p

Patient Demographics and Comorbidities at First Diagnosis of Atrial Flutter by Ablation Status.

<p>CTS, cardiothoracic surgery; IQR, interquartile range; SD, standard deviation.</p

Adjusted Hazard of Healthcare Utilization by Setting.

<p>Adjusted for age, gender, race, insurance, income, hypertension, diabetes, coronary artery disease, heart failure, remote history of cardiothoracic surgery, valvular heart disease, pulmonary disease, chronic kidney disease, neurologic disease, and atrial fibrillation. Overall healthcare utilization includes ambulatory surgery, inpatient, and emergency department encounters. CI, confidence interval; HR, hazard ratio.</p

Adjusted Hazard of Healthcare Utilization, Atrial Fibrillation, or Stroke After Atrial Flutter Ablation.

<p>Diamonds indicate the adjusted hazard ratio point estimates and error bars denote 95% confidence intervals. The dashed vertical line represents a hazard ratio of 1 (no difference with atrial flutter ablation).</p

Medical symptoms and conditions by product use, N = 34,279.

Medical symptoms and conditions by product use, N = 34,279.</p

Median number of cigarettes smoked per day among cigarette only users and dual users.

Dual use was associated with a slightly higher median number of cigarettes smoked per day (p < .0001). Error bars denote the interquartile range.</p

Prevalence of e-cigarette only, cigarette only, and dual use in the past 30 days by demographic characteristics and lifestyle and well-being factors in the health eheart study, N = 39,747^*.

<p>Prevalence of e-cigarette only, cigarette only, and dual use in the past 30 days by demographic characteristics and lifestyle and well-being factors in the health eheart study, N = 39,747^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0198681#t001fn001" target="_blank">*</a>}.</p

Percent of “yes” responses to past or current medical symptoms or conditions among cigarette only users and dual users.

<p>The only statistically significant difference between cigarette only users and dual users was arrhythmia (ADJ <i>p</i> = .02). Models adjusted for age, sex, race, education, cigarettes per day, and as needed, coronary artery disease, congestive heart failure, and COPD.</p

Median SF-36 general health scores, breathing difficulty “typically” scores, and breathing difficulty in the “past month” scores, among cigarette only users and dual users.

<p>Dual use was associated with lower (poorer) general health scores (ADJ <i>p</i> = .002) and higher (poorer) past month breathing difficulty scores (ADJ <i>p</i> = .001). Models adjusted for age, sex, race, education, cigarettes per day, coronary artery disease, congestive heart failure, and COPD. Error bars denote the interquartile range.</p