Outcomes of medicare beneficiaries undergoing catheter ablation for atrial fibrillation

Jonathan P. Piccini, Moritz F. Sinner, Melissa A. Greiner, Bradley G. Hammill, Joao Daniel T. Fontes, James P. Daubert, Patrick T. Ellinor, Adrian F. Hernandez, Allan J. Walkey, Susan R. Heckbert, Emelia J. Benjamin, Lesley H. Curtis

Research output: Contribution to journalArticle

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Abstract

Background-Atrial fibrillation is common among older persons. Catheter ablation is increasingly used in patients for whom medical therapy has failed. Methods and Results-We conducted a retrospective cohort study of all fee-for-service Medicare beneficiaries ≥65 years of age who underwent catheter ablation for atrial fibrillation between July 1, 2007, and December 31, 2009. The main outcome measures were major complications within 30 days and mortality, heart failure, stroke, hospitalization, and repeat ablation within 1 year. A total of 15 423 patients underwent catheter ablation for atrial fibrillation. Mean age was 72 years; 41% were women; and >95% were white. For every 1000 procedures, there were 17 cases of hemopericardium requiring intervention, 8 cases of stroke, and 8 deaths within 30 days. More than 40% of patients required hospitalization within 1 year; however, atrial fibrillation or flutter was the primary discharge diagnosis in only 38.4% of cases. Eleven percent of patients underwent repeat ablation within 1 year. Renal impairment (hazard ratio, 2.07; 95% confidence interval, 1.66-2.58), age ≥80 years (hazard ratio, 3.09; 95% confidence interval, 2.32-4.11), and heart failure (hazard ratio, 2.54; 95% confidence interval, 2.07-3.13) were major risk factors for 1-year mortality. Advanced age was a major risk factor for all adverse outcomes. Conclusions-Major complications after catheter ablation for atrial fibrillation were associated with advanced age but were fairly infrequent. Few patients underwent repeat ablation. Randomized trials are needed to inform risk-benefit calculations for older persons with drug-refractory, symptomatic atrial fibrillation.

Original languageEnglish (US)
Pages (from-to)2200-2207
Number of pages8
JournalCirculation
Volume126
Issue number18
DOIs
StatePublished - Oct 30 2012
Externally publishedYes

Fingerprint

Catheter Ablation
Medicare
Atrial Fibrillation
Confidence Intervals
Hospitalization
Heart Failure
Stroke
Fee-for-Service Plans
Atrial Flutter
Pericardial Effusion
Mortality
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Kidney
Pharmaceutical Preparations

Keywords

  • atrial fibrillation
  • catheter ablation
  • Medicare
  • outcome assessment (health care)

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Piccini, J. P., Sinner, M. F., Greiner, M. A., Hammill, B. G., Fontes, J. D. T., Daubert, J. P., ... Curtis, L. H. (2012). Outcomes of medicare beneficiaries undergoing catheter ablation for atrial fibrillation. Circulation, 126(18), 2200-2207. https://doi.org/10.1161/CIRCULATIONAHA.112.109330

Outcomes of medicare beneficiaries undergoing catheter ablation for atrial fibrillation. / Piccini, Jonathan P.; Sinner, Moritz F.; Greiner, Melissa A.; Hammill, Bradley G.; Fontes, Joao Daniel T.; Daubert, James P.; Ellinor, Patrick T.; Hernandez, Adrian F.; Walkey, Allan J.; Heckbert, Susan R.; Benjamin, Emelia J.; Curtis, Lesley H.

In: Circulation, Vol. 126, No. 18, 30.10.2012, p. 2200-2207.

Research output: Contribution to journalArticle

Piccini, JP, Sinner, MF, Greiner, MA, Hammill, BG, Fontes, JDT, Daubert, JP, Ellinor, PT, Hernandez, AF, Walkey, AJ, Heckbert, SR, Benjamin, EJ & Curtis, LH 2012, 'Outcomes of medicare beneficiaries undergoing catheter ablation for atrial fibrillation', Circulation, vol. 126, no. 18, pp. 2200-2207. https://doi.org/10.1161/CIRCULATIONAHA.112.109330
Piccini, Jonathan P. ; Sinner, Moritz F. ; Greiner, Melissa A. ; Hammill, Bradley G. ; Fontes, Joao Daniel T. ; Daubert, James P. ; Ellinor, Patrick T. ; Hernandez, Adrian F. ; Walkey, Allan J. ; Heckbert, Susan R. ; Benjamin, Emelia J. ; Curtis, Lesley H. / Outcomes of medicare beneficiaries undergoing catheter ablation for atrial fibrillation. In: Circulation. 2012 ; Vol. 126, No. 18. pp. 2200-2207.
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abstract = "Background-Atrial fibrillation is common among older persons. Catheter ablation is increasingly used in patients for whom medical therapy has failed. Methods and Results-We conducted a retrospective cohort study of all fee-for-service Medicare beneficiaries ≥65 years of age who underwent catheter ablation for atrial fibrillation between July 1, 2007, and December 31, 2009. The main outcome measures were major complications within 30 days and mortality, heart failure, stroke, hospitalization, and repeat ablation within 1 year. A total of 15 423 patients underwent catheter ablation for atrial fibrillation. Mean age was 72 years; 41{\%} were women; and >95{\%} were white. For every 1000 procedures, there were 17 cases of hemopericardium requiring intervention, 8 cases of stroke, and 8 deaths within 30 days. More than 40{\%} of patients required hospitalization within 1 year; however, atrial fibrillation or flutter was the primary discharge diagnosis in only 38.4{\%} of cases. Eleven percent of patients underwent repeat ablation within 1 year. Renal impairment (hazard ratio, 2.07; 95{\%} confidence interval, 1.66-2.58), age ≥80 years (hazard ratio, 3.09; 95{\%} confidence interval, 2.32-4.11), and heart failure (hazard ratio, 2.54; 95{\%} confidence interval, 2.07-3.13) were major risk factors for 1-year mortality. Advanced age was a major risk factor for all adverse outcomes. Conclusions-Major complications after catheter ablation for atrial fibrillation were associated with advanced age but were fairly infrequent. Few patients underwent repeat ablation. Randomized trials are needed to inform risk-benefit calculations for older persons with drug-refractory, symptomatic atrial fibrillation.",
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AU - Piccini, Jonathan P.

AU - Sinner, Moritz F.

AU - Greiner, Melissa A.

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AU - Fontes, Joao Daniel T.

AU - Daubert, James P.

AU - Ellinor, Patrick T.

AU - Hernandez, Adrian F.

AU - Walkey, Allan J.

AU - Heckbert, Susan R.

AU - Benjamin, Emelia J.

AU - Curtis, Lesley H.

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N2 - Background-Atrial fibrillation is common among older persons. Catheter ablation is increasingly used in patients for whom medical therapy has failed. Methods and Results-We conducted a retrospective cohort study of all fee-for-service Medicare beneficiaries ≥65 years of age who underwent catheter ablation for atrial fibrillation between July 1, 2007, and December 31, 2009. The main outcome measures were major complications within 30 days and mortality, heart failure, stroke, hospitalization, and repeat ablation within 1 year. A total of 15 423 patients underwent catheter ablation for atrial fibrillation. Mean age was 72 years; 41% were women; and >95% were white. For every 1000 procedures, there were 17 cases of hemopericardium requiring intervention, 8 cases of stroke, and 8 deaths within 30 days. More than 40% of patients required hospitalization within 1 year; however, atrial fibrillation or flutter was the primary discharge diagnosis in only 38.4% of cases. Eleven percent of patients underwent repeat ablation within 1 year. Renal impairment (hazard ratio, 2.07; 95% confidence interval, 1.66-2.58), age ≥80 years (hazard ratio, 3.09; 95% confidence interval, 2.32-4.11), and heart failure (hazard ratio, 2.54; 95% confidence interval, 2.07-3.13) were major risk factors for 1-year mortality. Advanced age was a major risk factor for all adverse outcomes. Conclusions-Major complications after catheter ablation for atrial fibrillation were associated with advanced age but were fairly infrequent. Few patients underwent repeat ablation. Randomized trials are needed to inform risk-benefit calculations for older persons with drug-refractory, symptomatic atrial fibrillation.

AB - Background-Atrial fibrillation is common among older persons. Catheter ablation is increasingly used in patients for whom medical therapy has failed. Methods and Results-We conducted a retrospective cohort study of all fee-for-service Medicare beneficiaries ≥65 years of age who underwent catheter ablation for atrial fibrillation between July 1, 2007, and December 31, 2009. The main outcome measures were major complications within 30 days and mortality, heart failure, stroke, hospitalization, and repeat ablation within 1 year. A total of 15 423 patients underwent catheter ablation for atrial fibrillation. Mean age was 72 years; 41% were women; and >95% were white. For every 1000 procedures, there were 17 cases of hemopericardium requiring intervention, 8 cases of stroke, and 8 deaths within 30 days. More than 40% of patients required hospitalization within 1 year; however, atrial fibrillation or flutter was the primary discharge diagnosis in only 38.4% of cases. Eleven percent of patients underwent repeat ablation within 1 year. Renal impairment (hazard ratio, 2.07; 95% confidence interval, 1.66-2.58), age ≥80 years (hazard ratio, 3.09; 95% confidence interval, 2.32-4.11), and heart failure (hazard ratio, 2.54; 95% confidence interval, 2.07-3.13) were major risk factors for 1-year mortality. Advanced age was a major risk factor for all adverse outcomes. Conclusions-Major complications after catheter ablation for atrial fibrillation were associated with advanced age but were fairly infrequent. Few patients underwent repeat ablation. Randomized trials are needed to inform risk-benefit calculations for older persons with drug-refractory, symptomatic atrial fibrillation.

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