Readmissions and repeat procedures after catheter ablation for atrial fibrillation

Background: The aim of this study was to assess the frequency of all-cause rehospitalization and due to atrial fibrillation/flutter (AF/AFl), repeat ablation of AF/AFl, mortality within 30 days and 1-year follow-up in patients after AF/AFl ablation procedure. Methods: Using data from the National Health Fund we identified a database comprising 2,022 patients who underwent AF/AFl ablation between January, 2012 and December, 2012 in Poland. The primary endpoint was readmission to hospital with discharge diagnosis AF/AFl. The secondary endpoints included: repeat AF/AFl ablation, cardiovascular hospitalization, all-cause hospitalization, all-cause mortality assessed in 30-day and 1-year time frame. Results: The mean age was 58.6 ± 10.9 years (66.8% male). The mean time of the index ablation hospitalization was 3.8 ± 2.6 days. After discharge, 123 (6.1%) and 540 (26.7%) patients were hospitalized because of AF/AFl within 30 days and 1 year, respectively. During 1-year follow-up, 192 (9.5%) patients underwent subsequent AF/AFl ablations. The patients that underwent the second ablation were younger (56.6 ± 11.0 vs. 59.1 ± 10.8; p = 0.019) and the time of the index hospitalization was shorter (3.75 ± 2.16 vs. 4.45 ± 3.26; p = 0.03). Within 30 days 194 (9.6%) patients were hospitalized and 747 (36.9%) in 1-year follow-up. All-cause mortality was 0.1% and 1.4% in 30-day and 1-year follow-up, respectively. In a 1-year follow-up patients hospitalized from AF/AFl recurrence were more frequently hospital­ized due to cardiovascular diseases other than AF/AFl (9.6% vs. 6.7%; p = 0.026), especially due to hypertension (2.9% vs. 0.7%; p < 0.001). Conclusions: Over 1 out of 4 patients who underwent AF/AFl ablation were hospitalized due to arrhythmia recurrence in 1 year

Risk sharing arrangements for pharmaceuticals: potential considerations and recommendations for European payers

<p>Abstract</p> <p>Background</p> <p>There has been an increase in 'risk sharing' schemes for pharmaceuticals between healthcare institutions and pharmaceutical companies in Europe in recent years as an additional approach to provide continued comprehensive and equitable healthcare. There is though confusion surrounding the terminology as well as concerns with existing schemes.</p> <p>Methods</p> <p>Aliterature review was undertaken to identify existing schemes supplemented with additional internal documents or web-based references known to the authors. This was combined with the extensive knowledge of health authority personnel from 14 different countries and locations involved with these schemes.</p> <p>Results and discussion</p> <p>A large number of 'risk sharing' schemes with pharmaceuticals are in existence incorporating both financial-based models and performance-based/outcomes-based models. In view of this, a new logical definition is proposed. This is "<it>risk sharing' schemes should be considered as agreements concluded by payers and pharmaceutical companies to diminish the impact on payers' budgets for new and existing schemes brought about by uncertainty and/or the need to work within finite budgets</it>". There are a number of concerns with existing schemes. These include potentially high administration costs, lack of transparency, conflicts of interest, and whether health authorities will end up funding an appreciable proportion of a new drug's development costs. In addition, there is a paucity of published evaluations of existing schemes with pharmaceuticals.</p> <p>Conclusion</p> <p>We believe there are only a limited number of situations where 'risk sharing' schemes should be considered as well as factors that should be considered by payers in advance of implementation. This includes their objective, appropriateness, the availability of competent staff to fully evaluate proposed schemes as well as access to IT support. This also includes whether systematic evaluations have been built into proposed schemes.</p