Objective: To identify possible racial and/or health insurance disparities with respect to ablation procedures for atrial fibrillation (AF). Method: Using the Nationwide Inpatient Sample (2000-2011), we identified adult patients (pts) admitted with principle diagnosis of AF by ICD 9 code 427.31 who had catheter ablation (ICD 9 code - 37.34). We stratified patients by race (White, Black, Hispanic, and other minority racial groups), insurance status, age, gender, type of hospital, and type of hospital admission. A hierarchical mixed effect multivariate model was created to identify independent predictors of AF ablation. Results: Among 4,547,144 patients hospitalized with AF during the study period, 201,447(4.43%) underwent ablation procedures. In absolute numbers, the majority of the ablations were performed in Whites (65.7%) and patients with Medicare (66.7%) or private insurance (24.7%). After adjusting for confounding factors, the proportions of Black pts (compare to White), and Medicare, Medicaid, and Uninsured pts (compare to private insurance), receiving ablation therapy were lower (see table). Odds of having ablation were lower in older and female patients and higher in teaching hospitals and after elective admissions (p<0.001 for all comparisions). Similar racial and insurance disparities were observed over the time course of the study. Conclusion: We identified lower rates of AF ablation among black pts even after correction of other factors such as insurance. Ablation rates were also lower among patients without private insurance. These trends persisted during the study period of 2000-2011.
Introduction: Percutaneous coronary intervention (PCI) volume is often used as a surrogate to define quality and maintain proficiency (> 75 PCI/year). Currently there lacks definite evidence to sup...
Abstract OBJECTIVES The aim of this study was to compare clinical outcomes of transcatheter and surgical mitral valve repair (SMVr) in primary mitral regurgitation (MR) and MR with heart failure with reduced ejection fraction (HFrEF). METHODS In this retrospective cohort study, we used the Nationwide Readmission Database to identify primary MR and MR with HFrEF patients who underwent transcatheter or SMVr from 2016 to 2019. A propensity score with 1:1 matching was applied. The primary outcome was a cumulative event rate of major adverse cardiovascular events (MACE), which was a composite of all-cause mortality, myocardial infarction, stroke, heart failure, cardiac arrest and mitral valve replacement. Other important secondary outcome was in-hospital mortality. RESULTS After propensity score matching, 2187 matched pairs were found in the primary MR cohort and 2178 matched pairs were found in the MR-HFrEF cohort. Transcatheter mitral valve repair (TMVr) had significantly higher medium-term MACE compared with SMVr in both cohorts (primary MR: hazard ratio: 1.73, 95% confidence interval: 1.33–2.26, P ≤ 0.001; MR-HFrEF: hazard ratio: 2.00, 95% confidence interval: 1.58–2.54, P ≤ 0.001). TMVr showed similar in-hospital mortality in both cohorts. CONCLUSIONS Although TMVr showed better short-term outcomes, it had significantly higher medium-term MACE than SMVr in both cohorts. Thus, shared decision-making should be performed for TMVr after discussing the benefits and risks in patients who can undergo SMVr.
Background Chronic kidney disease (CKD) is a well‐known risk factor for coronary artery disease and is associated with poor outcomes following an acute coronary syndrome (NSTE‐ACS). The optimal timing of an invasive strategy in patients with CKD and NSTE‐ACS is unclear. Hypothesis Timing of PCI in CKD patients will not affect the risk of mortality or incidence of dialysis. Methods We queried the National Inpatient Sample database (NIS) to identify cases with NSTEMI and CKD. Patients who underwent percutaneous coronary intervention (PCI) day 0 or 1 vs day 2 or 3 after admission were categorized as early vs delayed PCI, respectively. The primary outcomes of the study were in‐hospital mortality and acute kidney injury requiring hemodialysis (AKI‐D). The secondary outcomes were length of stay and hospital charges. Baseline characteristics were balanced using propensity score matching (PSM). Results After PSM, 3708 cases from the delayed PCI group were matched with 3708 cases from the early PCI group. The standardized mean differences between the 2 groups were substantially reduced after PSM. All other recorded variables were balanced between the 2 groups. In the early and delayed PCI groups, the incidence of AKI‐D (2.5% vs 2.3%; P = 0.54) and in‐hospital mortality (1.9% vs 1.4%; P = 0.12) was similar. Hospital charges and length of stay were higher in the delayed PCI group. Conclusions The incidence of AKI‐D and in‐hospital mortality among patients with CKD and NSTE‐ACS were not significantly affected by the timing of PCI. However, delayed PCI added significant cost and length of stay. A prospective randomized study is required to validate this concept.
