Comparison of the Effect of Catheter Ablation for Atrial Fibrillation on All-Cause Hospitalization in Patients With Versus Without Heart Failure (from the Nationwide Readmission Database)

Abstract

Catheter ablation (CA) is associated with reduced arrhythmia recurrence and improved quality of life in patients with atrial fibrillation (AF). Heart failure (HF) is common in patients with AF and is associated with a high hospitalization burden. The real-world association between CA and rates of subsequent hospitalization in patients with AF and HF has not been well studied. Patients who underwent CA for AF during the middle 4 months of each year 2010 to 2015 were identified using the Nationwide Readmission Database. Patients were grouped according to the HF status and HF patients were stratified to reduced versus preserved ejection fraction (EF) using ICD-9 codes. Rates of all-cause hospitalization 120 days before and after index admission were compared using the McNemar's test, before and after matching for baseline characteristics. A total of 10,966 patients met inclusion criteria, including 1,950 with HF. In the HF group, all-cause hospitalization rates changed from 45.8% before CA to 33.2% after (p <0.001). Corresponding rates for non-HF patients were 23.8% and 19.7% (p< 0.001) with a greater relative reduction in hospitalizations seen in the HF group (27.5% vs 17.2%; p value <0.001). The difference in relative reduction persisted after adjustment by propensity score matching. The relative reduction in hospitalization rates was similar in HF patients with reduced and preserved EF with 25.2% and 28.5%, respectively. In conclusion, CA for AF was followed by a significant reduction in all-cause hospitalization rates. Patients with HF, regardless of EF, showed a greater reduction in admissions.