Causes and predictors of readmission in patients with atrial fibrillation undergoing catheter ablation: A national population-based cohort study

Shilpkumar Arora, Sopan Lahewala, Byomesh Tripathi, Varshil Mehta, Varun Kumar, Divya Chandramohan, Alejandro Lemor, Mihir Dave, Nileshkumar Patel, Nilay V. Patel, Ghanshyam Palamaner Subash Shantha, Juan Viles Gonzalez, Abhishek Deshmukh

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background--Reducing readmission after catheter ablation (CA) in atrial fibrillation (AF) is important. Methods and Results--We utilized National Readmission Data (NRD) 2010-2014. AF was identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnostic code 427.31 in the primary field, while first CA of AF was identified via ICD-9-procedure code 37.34. Any admission within 30 or 90 days of index admission was considered a readmission. Cox proportional hazard regression was used to adjust for confounders. The primary outcomes were 30- and 90-day readmissions and the secondary outcome was AF recurrence. In total, 1 128 372 patients with AF were identified from January 1, 2010 to September 30, 2014. Of which 37 360 (3.3%) underwent CA. Patients aged ≥65 years and female sex were less likely to receive CA for AF. Overall, 10.9% and 16.5% of CA patients were readmitted within 30 and 90 days post-CA, respectively. Most common causes of readmissions were arrhythmia (AF, atrial flutter), heart failure, pulmonary causes (pneumonia, chronic obstructive pulmonary disease) and bleeding complications (gastrointestinal bleed, intracranial hemorrhage). Patients with diabetes mellitus, heart failure, coronary artery disease (CAD), chronic pulmonary and kidney disease, prior stroke/transient ischemic attack (TIA), female sex, length of stay ≥2 and disposition to the facility were prone to higher 30- and 90-day readmissions post-CA. Predictors of increase in AF recurrence post-CA were female sex, diabetes mellitus, chronic pulmonary disease, and length of stay ≥2. Trends of 90-day readmission and AF recurrence were found to improve over the study period. Conclusions--We identified several demographic and clinical factors associated with the use of CA in AF, and short-term outcomes of the same, which could potentially help in the patient selection and improve outcomes.

Original languageEnglish (US)
Article numbere009294
JournalJournal of the American Heart Association
Volume7
Issue number12
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

Fingerprint

Patient Readmission
Catheter Ablation
Atrial Fibrillation
Cohort Studies
Population
International Classification of Diseases
Recurrence
Lung Diseases
Length of Stay
Diabetes Mellitus
Heart Failure
Atrial Flutter
Intracranial Hemorrhages
Transient Ischemic Attack
Chronic Renal Insufficiency
Chronic Obstructive Pulmonary Disease
Patient Selection
Cardiac Arrhythmias
Coronary Artery Disease
Pneumonia

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Causes
  • Readmission

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Causes and predictors of readmission in patients with atrial fibrillation undergoing catheter ablation : A national population-based cohort study. / Arora, Shilpkumar; Lahewala, Sopan; Tripathi, Byomesh; Mehta, Varshil; Kumar, Varun; Chandramohan, Divya; Lemor, Alejandro; Dave, Mihir; Patel, Nileshkumar; Patel, Nilay V.; Shantha, Ghanshyam Palamaner Subash; Viles Gonzalez, Juan; Deshmukh, Abhishek.

In: Journal of the American Heart Association, Vol. 7, No. 12, e009294, 01.06.2018.

Research output: Contribution to journalArticle

Arora, S, Lahewala, S, Tripathi, B, Mehta, V, Kumar, V, Chandramohan, D, Lemor, A, Dave, M, Patel, N, Patel, NV, Shantha, GPS, Viles Gonzalez, J & Deshmukh, A 2018, 'Causes and predictors of readmission in patients with atrial fibrillation undergoing catheter ablation: A national population-based cohort study', Journal of the American Heart Association, vol. 7, no. 12, e009294. https://doi.org/10.1161/JAHA.118.009294
Arora, Shilpkumar ; Lahewala, Sopan ; Tripathi, Byomesh ; Mehta, Varshil ; Kumar, Varun ; Chandramohan, Divya ; Lemor, Alejandro ; Dave, Mihir ; Patel, Nileshkumar ; Patel, Nilay V. ; Shantha, Ghanshyam Palamaner Subash ; Viles Gonzalez, Juan ; Deshmukh, Abhishek. / Causes and predictors of readmission in patients with atrial fibrillation undergoing catheter ablation : A national population-based cohort study. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 12.
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abstract = "Background--Reducing readmission after catheter ablation (CA) in atrial fibrillation (AF) is important. Methods and Results--We utilized National Readmission Data (NRD) 2010-2014. AF was identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnostic code 427.31 in the primary field, while first CA of AF was identified via ICD-9-procedure code 37.34. Any admission within 30 or 90 days of index admission was considered a readmission. Cox proportional hazard regression was used to adjust for confounders. The primary outcomes were 30- and 90-day readmissions and the secondary outcome was AF recurrence. In total, 1 128 372 patients with AF were identified from January 1, 2010 to September 30, 2014. Of which 37 360 (3.3{\%}) underwent CA. Patients aged ≥65 years and female sex were less likely to receive CA for AF. Overall, 10.9{\%} and 16.5{\%} of CA patients were readmitted within 30 and 90 days post-CA, respectively. Most common causes of readmissions were arrhythmia (AF, atrial flutter), heart failure, pulmonary causes (pneumonia, chronic obstructive pulmonary disease) and bleeding complications (gastrointestinal bleed, intracranial hemorrhage). Patients with diabetes mellitus, heart failure, coronary artery disease (CAD), chronic pulmonary and kidney disease, prior stroke/transient ischemic attack (TIA), female sex, length of stay ≥2 and disposition to the facility were prone to higher 30- and 90-day readmissions post-CA. Predictors of increase in AF recurrence post-CA were female sex, diabetes mellitus, chronic pulmonary disease, and length of stay ≥2. Trends of 90-day readmission and AF recurrence were found to improve over the study period. Conclusions--We identified several demographic and clinical factors associated with the use of CA in AF, and short-term outcomes of the same, which could potentially help in the patient selection and improve outcomes.",
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T1 - Causes and predictors of readmission in patients with atrial fibrillation undergoing catheter ablation

T2 - A national population-based cohort study

AU - Arora, Shilpkumar

AU - Lahewala, Sopan

AU - Tripathi, Byomesh

AU - Mehta, Varshil

AU - Kumar, Varun

AU - Chandramohan, Divya

AU - Lemor, Alejandro

AU - Dave, Mihir

AU - Patel, Nileshkumar

AU - Patel, Nilay V.

AU - Shantha, Ghanshyam Palamaner Subash

AU - Viles Gonzalez, Juan

AU - Deshmukh, Abhishek

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background--Reducing readmission after catheter ablation (CA) in atrial fibrillation (AF) is important. Methods and Results--We utilized National Readmission Data (NRD) 2010-2014. AF was identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnostic code 427.31 in the primary field, while first CA of AF was identified via ICD-9-procedure code 37.34. Any admission within 30 or 90 days of index admission was considered a readmission. Cox proportional hazard regression was used to adjust for confounders. The primary outcomes were 30- and 90-day readmissions and the secondary outcome was AF recurrence. In total, 1 128 372 patients with AF were identified from January 1, 2010 to September 30, 2014. Of which 37 360 (3.3%) underwent CA. Patients aged ≥65 years and female sex were less likely to receive CA for AF. Overall, 10.9% and 16.5% of CA patients were readmitted within 30 and 90 days post-CA, respectively. Most common causes of readmissions were arrhythmia (AF, atrial flutter), heart failure, pulmonary causes (pneumonia, chronic obstructive pulmonary disease) and bleeding complications (gastrointestinal bleed, intracranial hemorrhage). Patients with diabetes mellitus, heart failure, coronary artery disease (CAD), chronic pulmonary and kidney disease, prior stroke/transient ischemic attack (TIA), female sex, length of stay ≥2 and disposition to the facility were prone to higher 30- and 90-day readmissions post-CA. Predictors of increase in AF recurrence post-CA were female sex, diabetes mellitus, chronic pulmonary disease, and length of stay ≥2. Trends of 90-day readmission and AF recurrence were found to improve over the study period. Conclusions--We identified several demographic and clinical factors associated with the use of CA in AF, and short-term outcomes of the same, which could potentially help in the patient selection and improve outcomes.

AB - Background--Reducing readmission after catheter ablation (CA) in atrial fibrillation (AF) is important. Methods and Results--We utilized National Readmission Data (NRD) 2010-2014. AF was identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnostic code 427.31 in the primary field, while first CA of AF was identified via ICD-9-procedure code 37.34. Any admission within 30 or 90 days of index admission was considered a readmission. Cox proportional hazard regression was used to adjust for confounders. The primary outcomes were 30- and 90-day readmissions and the secondary outcome was AF recurrence. In total, 1 128 372 patients with AF were identified from January 1, 2010 to September 30, 2014. Of which 37 360 (3.3%) underwent CA. Patients aged ≥65 years and female sex were less likely to receive CA for AF. Overall, 10.9% and 16.5% of CA patients were readmitted within 30 and 90 days post-CA, respectively. Most common causes of readmissions were arrhythmia (AF, atrial flutter), heart failure, pulmonary causes (pneumonia, chronic obstructive pulmonary disease) and bleeding complications (gastrointestinal bleed, intracranial hemorrhage). Patients with diabetes mellitus, heart failure, coronary artery disease (CAD), chronic pulmonary and kidney disease, prior stroke/transient ischemic attack (TIA), female sex, length of stay ≥2 and disposition to the facility were prone to higher 30- and 90-day readmissions post-CA. Predictors of increase in AF recurrence post-CA were female sex, diabetes mellitus, chronic pulmonary disease, and length of stay ≥2. Trends of 90-day readmission and AF recurrence were found to improve over the study period. Conclusions--We identified several demographic and clinical factors associated with the use of CA in AF, and short-term outcomes of the same, which could potentially help in the patient selection and improve outcomes.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Causes

KW - Readmission

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