Healthcare utilization and clinical outcomes after ablation of atrial fibrillation in patients with and without insertable cardiac monitoring

Moussa C Mansour; Emily M Gillen; Audrey Garman; Sarah C Rosemas; Noreli Franco; Paul D Ziegler; Jesse M Pines

doi:10.1016/j.hroo.2021.12.005

Healthcare utilization and clinical outcomes after ablation of atrial fibrillation in patients with and without insertable cardiac monitoring

Heart Rhythm O2. 2022 Jan 7;3(1):79-90. doi: 10.1016/j.hroo.2021.12.005. eCollection 2022 Feb.

Authors

Moussa C Mansour¹, Emily M Gillen², Audrey Garman², Sarah C Rosemas³, Noreli Franco³, Paul D Ziegler³, Jesse M Pines⁴

Affiliations

¹ Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
² Panalgo LLC, Boston, Massachusetts.
³ Medtronic, Mounds View, Minnesota.
⁴ US Acute Care Solutions, Canton, Ohio.

Abstract

Background: Compared with short-term electrocardiogram (ECG) monitors, insertable cardiac monitors (ICMs) have been shown to increase atrial fibrillation (AF) detection rates and the opportunity to treat recurrent AF in patients postablation.

Objective: To examine healthcare utilization and clinical outcomes following AF ablation, in patients with vs without ICM.

Methods: Retrospective analysis pooling Optum Clinformatics and Medicare Fee-for-service 5% Sample claims databases. Patients with an AF ablation between January 1, 2011, and March 31, 2018 who received an ICM implant within 1 year pre-/postablation were propensity score matched 1:3 to patients without ICM. Outcomes included AF-related healthcare utilization, medication use, and occurrence of composite severe cardiovascular events (stroke / transient ischemic attack, major bleeds, systemic embolism, AF- or heart failure-related hospitalization, or death).

Results: A total of 1000 ICM patients and 2998 non-ICM patients were included. During mean follow-up of 33 ± 16 months postablation, ICM patients experienced significantly fewer severe cardiovascular events (1.09 ± 2.22 vs 1.37 ± 4.19, P = .008) and associated costs ($20,757 vs $29,106, P = .0005). ICM patients had a greater number of AF-related clinic visits (16.8 vs 11.6 visits, P < .0001) and were more likely to receive a repeat ablation (38.7% vs 32.4%, P = .0003). Total all-cause costs during follow-up were not statistically different. Discontinuation of oral anticoagulation was higher in ICM patients at 1 year (44% vs 31%, P < .0001) and 2 years (73% vs 64%, P = .0012).

Conclusion: A shift from acute, reactive care to routine outpatient management was observed in patients with long-term ECG monitoring. Results suggest closer patient management in patients with long-term monitoring after an AF ablation and an improvement in outcomes, at similar overall cost.

Keywords: Ablation; Atrial fibrillation; Healthcare economics; Insertable cardiac monitor; Oral anticoagulation.