Healthcare utilization and clinical outcomes after ablation of atrial fibrillation in patients with and without insertable cardiac monitoring.
Healthcare utilization and clinical outcomes after ablation of atrial fibrillation in patients with and without insertable cardiac monitoring.
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DOI：
10.1016/j.hroo.2021.12.005
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Pines JM
中科院分区：
文献类型：
--
作者：
Mansour MC;Gillen EM;Garman A;Rosemas SC;Franco N;Ziegler PD;Pines JM
与短期心电图 (ECG) 监测仪相比，插入式心脏监测仪 (ICM) 已被证明可以提高心房颤动 (AF) 的检出率以及治疗消融后患者复发性 AF 的机会。旨在检查 AF 消融后，有 ICM 和无 ICM 的患者的医疗保健利用率和临床结果。回顾性分析汇集了 Optum Clinformatics 和 Medicare 按服务收费 5% 的索赔数据库样本。 2011年1月1日至2018年3月31日期间接受房颤消融并在消融前/消融后1年内接受ICM植入的患者的倾向评分与未接受ICM的患者进行1:3匹配。结果包括房颤相关的医疗保健利用、药物使用以及复合严重心血管事件的发生（中风/短暂性脑缺血发作、大出血、全身性栓塞、房颤或心力衰竭相关的住院治疗或死亡）。总共包括 1000 名 ICM 患者和 2998 名非 ICM 患者。在消融后 33 ± 16 个月的平均随访期间，ICM 患者经历的严重心血管事件显着减少（1.09 ± 2.22 vs 1.37 ± 4.19，P = .008）和相关费用（20,757 美元 vs 29,106 美元，P = .0005）。 ICM 患者的 AF 相关门诊就诊次数较多（16.8 次 vs 11.6 次就诊，P < .0001），并且更有可能接受重复消融（38.7% vs 32.4%，P = .0003）。随访期间的总全因成本没有统计学差异。 ICM 患者在 1 年（44% vs 31%，P < .0001）和 2 年（73% vs 64%，P = .0012）时停止口服抗凝药物的比例较高。在长期心电图监测的患者中观察到从急性、反应性护理到常规门诊管理的转变。结果表明，对房颤消融后进行长期监测的患者进行更严格的患者管理，并以相似的总体成本改善结果。
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. To examine healthcare utilization and clinical outcomes following AF ablation, in patients with vs without ICM. 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). 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). 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.
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影响因子：
37.8
作者：
January CT;Wann LS;Alpert JS;Calkins H;Cigarroa JE;Cleveland JC Jr;Conti JB;Ellinor PT;Ezekowitz MD;Field ME;Murray KT;Sacco RL;Stevenson WG;Tchou PJ;Tracy CM;Yancy CW;ACC/AHA Task Force Members
通讯作者：
ACC/AHA Task Force Members
影响因子：
1.8
作者：
Zuern, Christine S.;Kilias, Antonios;Schreieck, Juergen
通讯作者：
Schreieck, Juergen
影响因子：
24
作者：
Tilz, Roland Richard;Rillig, Andreas;Ouyang, Feifan
通讯作者：
Ouyang, Feifan
DOI：
10.1161/circoutcomes.110.958165
发表时间：
2011-05-01
影响因子：
6.9
作者：
Kim, Michael H.;Johnston, Stephen S.;Schulman, Kathy L.
通讯作者：
Schulman, Kathy L.
影响因子：
2.7
作者：
Lohrmann, Graham;Kaplan, Rachel;Passman, Rod
通讯作者：
Passman, Rod