Abstract 1057: Geography or Pathology? Regional Variation in Atrial Septal Defect Closure Rates and Techniques
Background: Since the introduction of percutaneous closure (PC) in the U.S., rates of atrial septal defect (ASD) and patent foramen ovale (PFO) closures have increased substantially. Whether or not contemporary closure rates are uniform or vary due to differences in regional practice patterns is unknown. We sought to answer this question by comparing regional rates of ASD and PFO closure across Florida.
Methods: We identified all ASD and PFO closures from 2001 to 2006 in the Florida State Inpatient Database. Using small area analysis, zip codes were assigned to Hospital Referral Regions based on where patients were most likely to go for closure. We then determined population-normalized rates of overall, PC and surgical closure.
Results: Of 1830 ASD and PFO closures from 2001–2006, 751 were surgical and 1004 were PC. The statewide closure rate was 1.91 per 100,000 people per year; regional rates varied 3.8-fold from 0.78 to 2.94 per 100,000 people per year. PC rates varied 7-fold from 0.25 to 1.75 per 100,000 people per year, while surgical rates varied 2.71 fold from 0.53 to 1.44 per 100,000 people per year. (Figure⇓)
Conclusion: The statewide rate of ASD and PFO closure increased in 2001, concurrent with the introduction of PC. However, despite a relatively consistent prevalence of ASD and PFO, rates of repair vary widely across regions. This suggests that closure of ASD and PFO is driven largely by provider practice patterns rather than patient pathology. Efforts should be directed towards increasing consensus regarding the appropriate, evidence-based indications for ASD and PFO closure so as to avoid the costs and potential negative sequelae of over- or under-treatment.