Clinical InvestigationElectrophysiologyGeographic variation in the use of catheter ablation for atrial fibrillation among Medicare beneficiaries
Section snippets
Methods
We obtained a 100% sample of claims data from the US Centers for Medicare & Medicaid Services for patients ≥65 years who underwent catheter ablation for atrial fibrillation. All included patients were enrolled in fee-for-service Medicare and were living in the United States at the time of the procedure. As previously reported,6 we identified and included patients from inpatient, outpatient, carrier, and denominator files who underwent intracardiac catheter ablation (Current Procedural
Results
Of 306 HRRs in total, 274 were eligible for the catheter ablation analysis after exclusions. Across the eligible HRRs, a total of 20,176 catheter ablations were performed in Medicare fee-for-service patients between 2007 and 2009. Across HRRs, the median age of patients undergoing catheter ablation for atrial fibrillation was 71.2 years (interquartile range 70.5-71.8) (Table I). A median of 39% (interquartile range 33.3%-45.5%) were women, and a median of <1% (interquartile range 0%-1.9%) were
Discussion
We observed substantial geographic variation in the use of catheter ablation for atrial fibrillation in Medicare fee-for-service beneficiaries. The variation in ablations did not correspond to the underlying prevalence of atrial fibrillation. Although the age-adjusted prevalence of atrial fibrillation was greatest in the major metropolitan areas of the East and West Coasts, catheter ablation rates were higher in areas where the prevalence of atrial fibrillation was relatively low. Hospital
Acknowledgements
Disclosures: Dr Piccini reported serving as a consultant for Janssen Pharmaceuticals, BMS/Pfizer, and Medtronic; and receiving grant funding from ARCA biopharma, GE Healthcare, and Janssen Pharmaceuticals. Dr Curtis reported receiving grant funding from GlaxoSmithKline, Johnson & Johnson, and GE Healthcare. Drs Piccini and Curtis have made available online detailed listings for financial disclosures (https://www.dcri.org/about-us/conflict-of-interest). No other disclosures were reported.
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Cited by (10)
Variations in Atrial Fibrillation Ablation Use and Charges in a Modern Cohort of Medicare Beneficiaries
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2020, Heart RhythmCitation Excerpt :Second, there is a significant increase in costs with repeat ablation that emphasizes the need to improve procedural efficacy and patient selection.150 Third, there are marked geographic variances in AF ablation that do not correlate with regional disease prevalence.151 Finally, there is also significant variation in the facility costs associated with AF ablation (median: $25,100; 25th percentile: $18,900; 75th percentile: $35,600; 95th percentile: $57,800).
Trends and predictors of repeat catheter ablation for atrial fibrillation
2016, American Heart JournalCitation Excerpt :One-year procedural success rates are often cited in the literature and in discussions with patients, but it is important to note that longer-term follow-up data are comparatively scant and repeat ablation appears to be common among patients who are good candidates for a repeat procedure. Geographic variation in the utilization of AF ablation has been previously described in a large study of the Medicare population (n = 20,176).22 These geographic variations do not necessarily follow patterns of AF prevalence but reflect more broadly the geographic variations in practice patterns and preferences.
Atrial fibrillation ablation in heart failure patients: Where do we stand in 2023? – State of the art review
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2021, Journal of Cardiovascular Electrophysiology
Jeanne Poole, MD served as guest editor for this article.
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Drs Sinner and Piccini contributed equally to the work.