Abstract 17360: Catheter Ablation of Atrial Flutter Reduces Healthcare Utilization and Incident Atrial Fibrillation
Introduction Endocardial catheter ablation is a safe and highly effective treatment for atrial flutter (AFL). Although a single, small clinical trial has demonstrated a reduction in hospitalization and atrial fibrillation among AFL patients treated with ablation versus pharmacologic therapy, it is unknown if catheter ablation improves outcomes in real world populations.
Hypothesis AFL catheter ablation is associated with reductions in healthcare utilization, atrial fibrillation, and stroke.
Methods We identified patients from the Healthcare Cost and Utilization Project database who received care in a California hospital setting (emergency department, inpatient ward, or ambulatory surgery unit) with a diagnosis of AFL between 2005 and 2009. Patients with a prior or concurrent diagnosis of atrial fibrillation were excluded. AFL ablation procedures, medical diagnoses, and Charlson Comorbidity Index (CCI) scores were determined at each encounter using ICD-9 codes. Individuals were observed for repeat healthcare visits, incident atrial fibrillation, and incident stroke. Atrial fibrillation and stroke analyses were limited to individuals with a first encounter between 2006 and 2009 to ensure adequate exclusion of patients with prevalent outcomes.
Results Among 33,004 AFL patients observed for a median of 2.1 years, 2,733 (8.3%) underwent catheter ablation. In multivariate analysis controlling for demographics and CCI score, AFL ablation increased the risk of an ambulatory surgery encounter (HR 1.48, 95% CI 1.40-1.57, p<0.001) but lowered the risk of inpatient hospitalization (HR 0.87, 95% CI 0.83-0.92, p<0.001) and emergency department visits (HR 0.51, 95% 0.46-0.56, p<0.001). This resulted in an overall reduction in healthcare utilization with AFL ablation (HR 0.89, 95% CI 0.85-0.93, p<0.001). After adjusting for demographics and disease-specific risk factors, AFL ablation was associated with a reduced risk of atrial fibrillation (HR 0.87, 95% CI 0.79-0.95, p<0.01) but was not associated with a lower risk of stroke (HR 1.07, 95% CI 0.80-1.43, p=0.7).
Conclusions In a large, real world population, catheter ablation for AFL reduces overall healthcare utilization and incident atrial fibrillation.
- © 2012 by American Heart Association, Inc.