Thirty-day readmissions after atrial fibrillation catheter ablation in patients with heart failure.

BACKGROUND Randomized clinical trial data has demonstrated catheter ablation (CA) as a viable treatment modality for atrial fibrillation (AF). Patients with heart failure (HF) undergoing AF CA appear to derive improvements in quality of life and mortality compared to those treated with medical therapy (MT). Contemporary national data on 30-day readmissions after CA compared to MT among patients with HF are lacking. METHODS From the 2016 Nationwide Readmissions Databases, 749,776 (weighted national estimate: 1,421,673) AF HF patients were identified of which 2,204 (0.3%) underwent CA and 747,572 (99.7%) received MT. Propensity-matching balanced baseline clinical characteristics. Thirty-day readmission rates, causes, predictors, and costs of 30-day readmission were compared. RESULTS Among both the unmatched and matched cohorts, 30-day readmissions were lower for patients treated with CA compared to MT (16.8% vs 20.1%, p<0.001; and 16.8% vs 18.8%, p = 0.020). CA was associated with reduced risk of readmission compared to MT (OR 0.86, 95% CI: 0.77-0.97). HF exacerbation and arrythmias were the most common cause for 30-day readmission after CA. CA costs were higher during index hospitalization but similar to MT during readmission among the matched cohort ($15,858 ± $21,636 vs. $16,505 ± $29,171, p = 0.67). Predictors of readmission were largely non-modifiable risk factors among both the CA and MT groups. CONCLUSIONS Nearly 1 in 6 patients with HF are readmitted within 30-days after undergoing CA. In propensity matched analyses, CA was associated with decreased rate and risk for readmission compared to MT. CA has higher index hospitalization costs, but lower readmission costs. This article is protected by copyright. All rights reserved.