Outcomes of Medicare Beneficiaries Undergoing Catheter Ablation for Atrial Fibrillation

被引:114
|
作者
Piccini, Jonathan P. [1 ,2 ]
Sinner, Moritz F. [3 ,4 ,5 ]
Greiner, Melissa A. [1 ]
Hammill, Bradley G. [1 ]
Fontes, Joao D. [6 ]
Daubert, James P. [1 ,2 ]
Ellinor, Patrick T. [4 ]
Hernandez, Adrian F. [1 ,2 ]
Walkey, Allan J. [6 ]
Heckbert, Susan R. [8 ]
Benjamin, Emelia J. [3 ,6 ,7 ]
Curtis, Lesley H. [1 ,2 ]
机构
[1] Duke Univ, Duke Clin Res Inst, Sch Med, Durham, NC 27715 USA
[2] Duke Univ, Dept Med, Sch Med, Durham, NC 27715 USA
[3] Framingham Heart Dis Epidemiol Study, Framingham, MA USA
[4] Massachusetts Gen Hosp, Cardiovasc Res Ctr, Charlestown, MA USA
[5] Univ Munich, Dept Med 1, Univ Hosp Grosshadern, Munich, Germany
[6] Boston Univ, Sch Med, Dept Med, Boston, MA 02118 USA
[7] Boston Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA USA
[8] Univ Washington, Dept Epidemiol, Sch Publ Hlth, Seattle, WA 98195 USA
关键词
atrial fibrillation; catheter ablation; Medicare; outcome assessment (health care); CONGESTIVE-HEART-FAILURE; TERM CLINICAL-EFFICACY; LIFETIME RISK; UNITED-STATES; STROKE RISK; COMPLICATIONS; PREVALENCE; MORTALITY; TRENDS; REHOSPITALIZATIONS;
D O I
10.1161/CIRCULATIONAHA.112.109330
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Atrial fibrillation is common among older persons. Catheter ablation is increasingly used in patients for whom medical therapy has failed. Methods and Results-We conducted a retrospective cohort study of all fee-for-service Medicare beneficiaries >= 65 years of age who underwent catheter ablation for atrial fibrillation between July 1, 2007, and December 31, 2009. The main outcome measures were major complications within 30 days and mortality, heart failure, stroke, hospitalization, and repeat ablation within 1 year. A total of 15 423 patients underwent catheter ablation for atrial fibrillation. Mean age was 72 years; 41% were women; and >95% were white. For every 1000 procedures, there were 17 cases of hemopericardium requiring intervention, 8 cases of stroke, and 8 deaths within 30 days. More than 40% of patients required hospitalization within 1 year; however, atrial fibrillation or flutter was the primary discharge diagnosis in only 38.4% of cases. Eleven percent of patients underwent repeat ablation within 1 year. Renal impairment (hazard ratio, 2.07; 95% confidence interval, 1.66-2.58), age >= 80 years (hazard ratio, 3.09; 95% confidence interval, 2.32-4.11), and heart failure (hazard ratio, 2.54; 95% confidence interval, 2.07-3.13) were major risk factors for 1-year mortality. Advanced age was a major risk factor for all adverse outcomes. Conclusions-Major complications after catheter ablation for atrial fibrillation were associated with advanced age but were fairly infrequent. Few patients underwent repeat ablation. Randomized trials are needed to inform risk-benefit calculations for older persons with drug-refractory, symptomatic atrial fibrillation. (Circulation. 2012;126:2200-2207.)
引用
收藏
页码:2200 / +
页数:14
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