Effect of antiarrhythmic drug initiation on readmission after catheter ablation for atrial fibrillation

Peter Noseworthy, Holly K. Van Houten, Lindsey R. Sangaralingham, Abhishek J. Deshmukh, Suraj Kapa, Siva Mulpuru, Christopher J. McLeod, Samuel J Asirvatham, Paul Andrew Friedman, Nilay D Shah, Douglas L Packer

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives This study sought to evaluate the impact on antiarrhythmic drug (AAD) initiation on the risk of readmission after catheter ablation for atrial fibrillation (AF) among patients not already treated with an AAD. Background Hospital readmission, a commonly tracked indicator of quality and efficiency of care delivery, occurs in about 15% patients within 90 days of undergoing catheter ablation for AF. Methods Using a large national administrative claims database, we identified all atrial fibrillation patients (≥18 years of age) who underwent catheter ablation between January 2005 and December 2013 (n = 7,442). We identified the subset of patients who had not been on an AAD in the 90 days before ablation (n = 2,542) and, among those, the patients in whom an AAD was initiated at discharge following the ablation (n = 519). Results The readmission rate was significantly lower among patients who were initiated on an AAD compared with those who were not (11.6% vs. 16.2%, p = 0.009). The association persisted after adjustment for age, sex, Charlson index, and CHADS2 score (hazard ratio [HR]: 0.73, 95% confidence interval [CI]: 0.56 to 0.97; p = 0.03). In unadjusted time to event analysis, amiodarone (HR: 0.55, 95% CI: 0.32 to 0.94; p = 0.039) was associated with the greatest reduction in readmission whereas dronedarone, Class II agents, and Class IC agents had no statistically significant effect on readmission. AADs were discontinued in 44.5% of patients at 3 months. Conclusions Initiation of an AAD at discharge of catheter ablation is associated with a significant reduction in readmission within 90 days. Routine initiation of an AAD after catheter ablation may reduce healthcare utilization in the periablation period; however, the high rate of medication discontinuation may suggest that side effects or inefficacy may limit long-term AAD use post-ablation.

Original languageEnglish (US)
Pages (from-to)238-244
Number of pages7
JournalJACC: Clinical Electrophysiology
Volume1
Issue number4
DOIs
StatePublished - Aug 1 2015

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Catheter Ablation
Anti-Arrhythmia Agents
Atrial Fibrillation
Confidence Intervals
Patient Readmission
Amiodarone
Quality of Health Care
Databases
Delivery of Health Care

Keywords

  • ablation
  • atrial fibrillation
  • epidemiology
  • readmission

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Effect of antiarrhythmic drug initiation on readmission after catheter ablation for atrial fibrillation. / Noseworthy, Peter; Van Houten, Holly K.; Sangaralingham, Lindsey R.; Deshmukh, Abhishek J.; Kapa, Suraj; Mulpuru, Siva; McLeod, Christopher J.; Asirvatham, Samuel J; Friedman, Paul Andrew; Shah, Nilay D; Packer, Douglas L.

In: JACC: Clinical Electrophysiology, Vol. 1, No. 4, 01.08.2015, p. 238-244.

Research output: Contribution to journalArticle

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abstract = "Objectives This study sought to evaluate the impact on antiarrhythmic drug (AAD) initiation on the risk of readmission after catheter ablation for atrial fibrillation (AF) among patients not already treated with an AAD. Background Hospital readmission, a commonly tracked indicator of quality and efficiency of care delivery, occurs in about 15{\%} patients within 90 days of undergoing catheter ablation for AF. Methods Using a large national administrative claims database, we identified all atrial fibrillation patients (≥18 years of age) who underwent catheter ablation between January 2005 and December 2013 (n = 7,442). We identified the subset of patients who had not been on an AAD in the 90 days before ablation (n = 2,542) and, among those, the patients in whom an AAD was initiated at discharge following the ablation (n = 519). Results The readmission rate was significantly lower among patients who were initiated on an AAD compared with those who were not (11.6{\%} vs. 16.2{\%}, p = 0.009). The association persisted after adjustment for age, sex, Charlson index, and CHADS2 score (hazard ratio [HR]: 0.73, 95{\%} confidence interval [CI]: 0.56 to 0.97; p = 0.03). In unadjusted time to event analysis, amiodarone (HR: 0.55, 95{\%} CI: 0.32 to 0.94; p = 0.039) was associated with the greatest reduction in readmission whereas dronedarone, Class II agents, and Class IC agents had no statistically significant effect on readmission. AADs were discontinued in 44.5{\%} of patients at 3 months. Conclusions Initiation of an AAD at discharge of catheter ablation is associated with a significant reduction in readmission within 90 days. Routine initiation of an AAD after catheter ablation may reduce healthcare utilization in the periablation period; however, the high rate of medication discontinuation may suggest that side effects or inefficacy may limit long-term AAD use post-ablation.",
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AU - Noseworthy, Peter

AU - Van Houten, Holly K.

AU - Sangaralingham, Lindsey R.

AU - Deshmukh, Abhishek J.

AU - Kapa, Suraj

AU - Mulpuru, Siva

AU - McLeod, Christopher J.

AU - Asirvatham, Samuel J

AU - Friedman, Paul Andrew

AU - Shah, Nilay D

AU - Packer, Douglas L

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N2 - Objectives This study sought to evaluate the impact on antiarrhythmic drug (AAD) initiation on the risk of readmission after catheter ablation for atrial fibrillation (AF) among patients not already treated with an AAD. Background Hospital readmission, a commonly tracked indicator of quality and efficiency of care delivery, occurs in about 15% patients within 90 days of undergoing catheter ablation for AF. Methods Using a large national administrative claims database, we identified all atrial fibrillation patients (≥18 years of age) who underwent catheter ablation between January 2005 and December 2013 (n = 7,442). We identified the subset of patients who had not been on an AAD in the 90 days before ablation (n = 2,542) and, among those, the patients in whom an AAD was initiated at discharge following the ablation (n = 519). Results The readmission rate was significantly lower among patients who were initiated on an AAD compared with those who were not (11.6% vs. 16.2%, p = 0.009). The association persisted after adjustment for age, sex, Charlson index, and CHADS2 score (hazard ratio [HR]: 0.73, 95% confidence interval [CI]: 0.56 to 0.97; p = 0.03). In unadjusted time to event analysis, amiodarone (HR: 0.55, 95% CI: 0.32 to 0.94; p = 0.039) was associated with the greatest reduction in readmission whereas dronedarone, Class II agents, and Class IC agents had no statistically significant effect on readmission. AADs were discontinued in 44.5% of patients at 3 months. Conclusions Initiation of an AAD at discharge of catheter ablation is associated with a significant reduction in readmission within 90 days. Routine initiation of an AAD after catheter ablation may reduce healthcare utilization in the periablation period; however, the high rate of medication discontinuation may suggest that side effects or inefficacy may limit long-term AAD use post-ablation.

AB - Objectives This study sought to evaluate the impact on antiarrhythmic drug (AAD) initiation on the risk of readmission after catheter ablation for atrial fibrillation (AF) among patients not already treated with an AAD. Background Hospital readmission, a commonly tracked indicator of quality and efficiency of care delivery, occurs in about 15% patients within 90 days of undergoing catheter ablation for AF. Methods Using a large national administrative claims database, we identified all atrial fibrillation patients (≥18 years of age) who underwent catheter ablation between January 2005 and December 2013 (n = 7,442). We identified the subset of patients who had not been on an AAD in the 90 days before ablation (n = 2,542) and, among those, the patients in whom an AAD was initiated at discharge following the ablation (n = 519). Results The readmission rate was significantly lower among patients who were initiated on an AAD compared with those who were not (11.6% vs. 16.2%, p = 0.009). The association persisted after adjustment for age, sex, Charlson index, and CHADS2 score (hazard ratio [HR]: 0.73, 95% confidence interval [CI]: 0.56 to 0.97; p = 0.03). In unadjusted time to event analysis, amiodarone (HR: 0.55, 95% CI: 0.32 to 0.94; p = 0.039) was associated with the greatest reduction in readmission whereas dronedarone, Class II agents, and Class IC agents had no statistically significant effect on readmission. AADs were discontinued in 44.5% of patients at 3 months. Conclusions Initiation of an AAD at discharge of catheter ablation is associated with a significant reduction in readmission within 90 days. Routine initiation of an AAD after catheter ablation may reduce healthcare utilization in the periablation period; however, the high rate of medication discontinuation may suggest that side effects or inefficacy may limit long-term AAD use post-ablation.

KW - ablation

KW - atrial fibrillation

KW - epidemiology

KW - readmission

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