Abstract 14800: Impact of Payor Status on Presentation, Therapies, and Outcomes in 31,614 Patients Hospitalized with Wolff-Parkinson-White Syndrome

Abstract

Background: The risk of sudden cardiac death in Wolff-Parkinson-White (WPW) Syndrome is higher in symptomatic patients, especially those with syncope. Ablation is effective but requires significant medical resources. We assessed the mode of presentation and hospital course of patients hospitalized with WPW of different payor statuses.

Methods: Hospital records were obtained California, New Hampshire, New Jersey, Vermont, New York, and West Virginia for the years 1995-2007. Admissions including the ICD-9 CM code 426.7 (WPW) were analyzed. Data dictionaries and ICD-9 codes were used to quantify demographics and outcomes. Association of payor status with atrial fibrillation, syncope, unscheduled admission, admission via the emergency department, and radiofrequency ablation was estimated using univariate and multivariate binomial mixed effects model with random effects terms for hospital and state and age, gender and race as covariates.

Results: 31,614 hospital discharges included the diagnosis WPW. The average age at admission was 43.2 +/- 0.14 years old, 54% of patients were male, and 66.8% were white. White patients were significantly more likely to have private insurance than non-white (OR 1.95, p < 0.0001). In multivariate analysis, Medicaid patients were less likely than the privately insured to present with atrial fibrillation (OR 0.75, p < 0.0001), while uninsured patients were more likely to present with syncope (OR 1.29, p= 0.04). Compared with private insurance, Medicare, Medicaid, and no insurance were associated with a significantly higher likelihood of admission via the ED (OR 1.32, 1.5, 2.4, respectively, p < 0.0001 for all) and a lower likelihood of undergoing ablation (OR 0.35, 0.5, 0.55, respectively, p < 0.0001 for all).

Conclusions: WPW patients with Medicare, Medicaid, and no insurance are more likely to present to the hospital urgently or emergently and less likely to undergo definitive therapy with radiofrequency ablation.