Rates and predictors of hospital and emergency department care after catheter ablation of atrial fibrillation.
Rates and predictors of hospital and emergency department care after catheter ablation of atrial fibrillation.
复制标题
心房颤动导管消融术后医院和急诊科护理的发生率和预测因素。
DOI：
10.1111/jce.15841
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发表时间：
2023
影响因子：
2.7
通讯作者：
Piccini,JonathanP
中科院分区：
文献类型：
--
作者：
Friedman,DanielJ;Freeman,JamesV;Wong,Charlene;Febre,Janice;Iglesias,Maximiliano;Khanna,Rahul;Piccini,JonathanP
虽然房颤（AF）消融术已变得越来越安全，但消融术后仍可能发生再住院和急诊（艾德）评估。需要更好地了解消融术后住院和艾德评估的频率、原因和预测因素，特别是随着同一天出院计划的扩大，Optum Clinformatics数据库用于定义2016年1月至2019年5月期间房颤消融术后住院和艾德护理的发生率、原因和预测因素。主要结局为出院后30天内的全因住院和艾德护理。通过Logistic回归分析确定了全因艾德和住院治疗的独立预测因子。结果在本研究的18 848例患者中，平均年龄为67. 5 ± 10岁，37. 9%为女性，平均CHA 2 DS 2-VASc评分为3. 27 ± 1. 84。在房颤消融术后30天内，18848例患者中有1440例（7.6%）需要住院治疗，其中15%的患者入院次数>1次; 7.9%的患者需要艾德治疗，其中28.6%的患者艾德访视次数>1次。最常见的入院原因（平均在出院后12.3天发生）是室上性心动过速（SVT）或AF（33.2%）、心力衰竭（12.7%）和感染（12.2%）。艾德治疗的最常见原因是SVT/AF（15.0%）、非心源性胸痛（13.3%）和非感染性呼吸道疾病（12.2%）。年龄、女性、住院环境中的消融术和合并症与再住院风险增加相关。年龄、女性、患者合并症和不使用直接口服抗凝剂与艾德visit.ConclusionApproximately 7%-8%的患者在房颤消融术后需要计划外住院或艾德护理相关，最常见的原因是SVT/AF。计划外护理的预测因素包括患者年龄、性别和几种患者合并症。这项研究可以通过确定计划外护理的常见原因来告知质量改进措施。
IntroductionAlthough atrial fibrillation (AF) ablation has become increasingly safer, rehospitalization and emergency department (ED) evaluations can occur in the postablation period. Better understanding of the frequency, causes, and predictors for hospitalization and ED evaluation after ablation are needed, particularly as same‐day discharge programs expand.MethodsThe Optum Clinformatics database was used to define rates, causes, and predictors of hospital and ED care after AF ablation performed between January 2016 and May 2019. Primary outcomes were all‐cause hospital and ED care within 30 days of discharge. Independent predictors of all‐cause ED and hospital admissions care were determined via logistic regression.ResultsOf the 18 848 patients in this study, the mean age was 67.5 ± 10 years, 37.9% were female, and the mean CHA2DS2‐VASc score was 3.27 ± 1.84. Within 30 days of AF ablation, 1440 of 18 848 patients (7.6%) required hospital care of which 15% had >1 admission; 7.9% required ED care of which 28.6% had >1 ED visit. The most common reasons for hospital admission (which occurred on average 12.3 days after discharge) were supraventricular tachycardia (SVT) or AF (33.2%), heart failure (12.7%), and infection (12.2%). The most common reasons for ED care were SVT/AF (15.0%), noncardiac chest pain (13.3%), and noninfectious respiratory illness (12.2%). Age, female sex, ablation in an inpatient setting, and co‐morbidities were associated with increased risk of rehospitalization. Age, female sex, patient comorbidities, and non‐use of direct oral anticoagulation were associated with increased risk of ED visit.ConclusionApproximately 7%–8% of patients require unplanned hospitalization or ED care after AF ablation, most commonly due to SVT/AF. Predictors of unscheduled care include patient age, sex, and several patient comorbidities. This study can inform quality improvement initiatives by identifying common causes for unscheduled care.