Demographic Differences in Catheter Ablation After Hospital Presentation With Symptomatic Atrial Fibrillation.
Demographic Differences in Catheter Ablation After Hospital Presentation With Symptomatic Atrial Fibrillation.
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DOI：
10.1161/jaha.115.002097
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发表时间：
2015-09-22
影响因子：
5.4
通讯作者：
Kamel H
中科院分区：
文献类型：
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作者：
Kummer BR;Bhave PD;Merkler AE;Gialdini G;Okin PM;Kamel H
导管消融越来越多地用于症状性房颤（AF）的心律控制，但接受该手术的患者的人口统计学特征尚不清楚。我们使用了加州、佛罗里达和纽约非联邦急症护理医院的所有入院数据，以确定2006年至2011年期间出院时主要诊断为AF的患者。我们的主要结局是使用经验证的国际疾病分类第九次修订版临床修改程序代码确定的房颤导管消融术再入院。使用考克斯回归模型评估人口统计学特征与导管消融之间的关系，并调整Elixhauser合并症。我们确定了397612名合格患者。其中，16 717例（4.20%，95% CI 0.41 - 0.43）接受了消融术。这些患者明显更年轻，更常见的是男性，更常见的是白色，更常见的是私人保险，家庭收入更高，医疗并发症的发生率更低。在考克斯回归模型中，女性消融的可能性低于男性（风险比[HR] 0.83; 95% CI 0.80 - 0.86），尽管AF相关再住院率较高（HR 1.23; 95% CI 1.21 - 1.24）。与白人相比，西班牙裔的消融可能性较低（HR 0.60; 95% CI 0.56 - 0.64）和黑人（HR 0.68; 95% CI 0.64 - 0.73），尽管黑人AF相关再住院的可能性仅略低（HR 0.97; 95% CI 0.94 - 0.99）和全因住院的可能性更高（HR 1.38; 95% CI 1.37 - 1.39）。基本上同样的模式存在于西班牙裔。我们发现，尽管对人口统计学特征和医学合并症的可用数据进行了调整，但根据性别和种族，导管消融术在症状性房颤中的使用存在差异。
Catheter ablation is increasingly used for rhythm control in symptomatic atrial fibrillation (AF), but the demographic characteristics of patients undergoing this procedure are unclear. We used data on all admissions at nonfederal acute care hospitals in California, Florida, and New York to identify patients discharged with a primary diagnosis of AF between 2006 and 2011. Our primary outcome was readmission for catheter ablation of AF, identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. Cox regression models were used to assess relationships between demographic characteristics and catheter ablation, adjusting for Elixhauser comorbidities. We identified 397 612 eligible patients. Of these, 16 717 (4.20%, 95% CI 0.41 to 0.43) underwent ablation. These patients were significantly younger, more often male, more often white, and more often privately insured, with higher household incomes and lower rates of medical comorbidity. In Cox regression models, the likelihood of ablation was lower in women than men (hazard ratio [HR] 0.83; 95% CI 0.80 to 0.86) despite higher rates of AF-related rehospitalization (HR 1.23; 95% CI 1.21 to 1.24). Compared to whites, the likelihood of ablation was lower in Hispanics (HR 0.60; 95% CI 0.56 to 0.64) and blacks (HR 0.68; 95% CI 0.64 to 0.73), even though blacks had only a slightly lower likelihood of AF-related rehospitalization (HR 0.97; 95% CI 0.94 to 0.99) and a higher likelihood of all-cause hospitalization (HR 1.38; 95% CI 1.37 to 1.39). Essentially the same pattern existed in Hispanics. We found differences in use of catheter ablation for symptomatic AF according to sex and race despite adjustment for available data on demographic characteristics and medical comorbidities.