Catheter ablation and healthcare utilization and cost among patients with paroxysmal versus persistent atrial fibrillation

Daniel J Friedman; Michael E Field; Motiur Rahman; Laura Goldstein; Qun Sha; M Sidharth; Rahul Khanna; Jonathan P Piccini

doi:10.1016/j.hroo.2020.12.017

Catheter ablation and healthcare utilization and cost among patients with paroxysmal versus persistent atrial fibrillation

Heart Rhythm O2. 2020 Dec 15;2(1):28-36. doi: 10.1016/j.hroo.2020.12.017. eCollection 2021 Feb.

Authors

Daniel J Friedman¹, Michael E Field², Motiur Rahman³, Laura Goldstein⁴, Qun Sha⁵, M Sidharth⁶, Rahul Khanna³, Jonathan P Piccini⁷

Affiliations

¹ Section of Cardiac Electrophysiology, Yale School of Medicine, New Haven, Connecticut.
² Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
³ Johnson and Johnson, Medical Device Epidemiology, New Brunswick, New Jersey.
⁴ Johnson and Johnson, Franchise Health Economics and Market Access, Irvine, California.
⁵ Biosense Webster Inc, Franchise Medical Affairs, Irvine, California.
⁶ MuSigma Inc, Bengaluru, India.
⁷ Electrophysiology Section, Duke University Hospital & Duke Clinical Research Institute, Durham, North Carolina.

Abstract

Background: Ablation reduces atrial fibrillation (AF) burden and improves health-related quality of life. The relationship between ablation, healthcare utilization, and AF type (paroxysmal AF [PAF] vs persistent AF [PsAF]) remains unclear.

Objective: To compare changes in AF-related healthcare utilization and costs from preablation to postablation among patients with PAF and PsAF.

Methods: Patients (2794 PAF, 1909 PsAF) undergoing ablation (2016-2018) were identified using the Optum database. Outcomes included inpatient admissions, emergency department (ED) visits, office visits, cardioversion, and antiarrhythmic drug (AAD) use. Costs (2018 US$) and outcomes were compared for the year before/after ablation using the McNemar test and Wilcoxon signed rank test.

Results: Compared to PAF patients, PsAF patients were older (68.6 ± 9.0 years vs 67.4 ± 9.9 years, P < .0001), were less commonly female (36.3% vs 44.1%, P < .0001), and more commonly had a CHA₂DS₂-VASc ≥ 3(71.2% vs 62.7%, P < .0001). The 12-month postablation costs were lower for AF-specific inpatient admissions (PAF -28%, PsAF -33%), ED visits (PAF -76%, PsAF -70%), AAD prescription fills (PAF -25%, PsAF -7%), and cardioversions (PAF -59%, PsAF -55%) as compared to 12 months before ablation. Although these reductions were observed for both PAF and PsAF patients, absolute costs remained higher for PsAF. Total AF costs were higher during the 1 year after ablation vs before ablation (PAF: 11%, P < .0001; PsAF: 10%, P < .0001) owing to repeat ablation. However, in the 18-month follow-up analysis, postablation costs were overall reduced (PAF: 35%, P < .0001; PsAF: 34%, P < .0001), despite including costs from repeat ablation.

Conclusion: Significant reductions in healthcare utilization and costs were observed among PAF and PsAF patients undergoing ablation. These data suggest a strategy of earlier ablation may reduce long-term healthcare utilization and costs.

Keywords: Ablation; Atrial fibrillation; Cost; Healthcare economics; Healthcare utilization.