Background— Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The associated morbidity and mortality make AF a major public health burden. Hospitalizations account for the majority of the economic cost burden associated with AF. The main objective of this study is to examine the trends of AF-related hospitalizations in the United States and to compare patient characteristics, outcomes, and comorbid diagnoses. Methods and Results— With the use of the Nationwide Inpatient Sample from 2000 through 2010, we identified AF-related hospitalizations using International Classification of Diseases, 9th Revision, Clinical Modification code 427.31 as the principal discharge diagnosis. Overall AF hospitalizations increased by 23% from 2000 to 2010, particularly in patients ≥65 years of age. The most frequent coexisting conditions were hypertension (60.0%), diabetes mellitus (21.5%), and chronic pulmonary disease (20.0%). Overall in-hospital mortality was 1%. The mortality rate was highest in the group of patients ≥80 years of age (1.9%) and in the group of patients with concomitant heart failure (8.2%). In-hospital mortality rate decreased significantly from 1.2% in 2000 to 0.9% in 2010 (29.2% decrease; P <0.001). Although there was no significant change in mean length of stay, mean cost of AF hospitalization increased significantly from $6410 in 2001 to $8439 in 2010 (24.0% increase; P <0.001). Conclusions— Hospitalization rates for AF have increased exponentially among US adults from 2000 to 2010. The proportion of comorbid chronic diseases has also increased significantly. The last decade has witnessed an overall decline in hospital mortality; however, the hospitalization cost has significantly increased.

No abstract

1 and the 2011 percutaneous coronary intervention (PCI) guidelines recommend (Class IC) that PCIs should be performed by operators with an annual volume (>75 procedures) at high-volume centers (>400 procedures) with on-site cardiac surgery. 2 The last decade has observed a decline in number of PCIs performed, and many interventional cardiologists have experienced a drop in procedural volume. 3,4 As a result, the Background-The relationship between operator or institutional volume and outcomes among patients undergoing percutaneous coronary interventions (PCI) is unclear. Methods and Results-Cross-sectional study based on the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample between 2005 to 2009. Subjects were identified by International Classification of Diseases, 9 th Revision, Clinical Modification procedure code, 36.06 and 36.07. Annual operator and institutional volumes were calculated using unique identification numbers and then divided into quartiles. Three-level hierarchical multivariate mixed models were created. The primary outcome was in-hospital mortality; secondary outcome was a composite of in-hospital mortality and peri-procedural complications. A total of 457 498 PCIs were identified representing a total of 2 243 209 PCIs performed in the United States during the study period. In-hospital, all-cause mortality was 1.08%, and the overall complication rate was 7.10%. ]. Spline analysis also showed significant operator and institutional volume outcome relationship. Similarly operators in the higher quartiles witnessed a significant reduction in length of hospital stay and cost of hospitalization (P<0.001). Conclusions-Overall in-hospital mortality after PCI was low. An increase in operator and institutional volume of PCI was found to be associated with a decrease in adverse outcomes, length of hospital stay, and cost of hospitalization. 5 These recommendations, however, are based on expert opinion derived from the interpretation of data from multiple sources with inherent limitations. Some of these data were derived from state registries and are dated. 5-24The purpose of this study was to determine the association of annual PCI operator and institutional volume with in-hospital mortality, peri-procedural complications, length of hospital stay, and cost of hospitalization using the nation's largest available all-payer insurance inpatient database in a recent era (2005)(2006)(2007)(2008)(2009)) during which procedural techniques and practices have remained relatively stable. Methods Data SourceWe analyzed 5-year data from the 2005 to 2009 from National Inpatient Sample (NIS) database. The NIS is a subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality (AHRQ). The NIS is the largest publicly available all-payer inpatient care database in the United States; including data on approximately 7 to 8 million discharges per year, it is stratified to sample approximately 20% sample of US community (nonfederal, short-term, general, a...

No abstract

No abstract

No abstract

We appreciate Khera and colleagues for their interest in our study on the percutaneous coronary intervention (PCI) volume-outcome relationship.1 Khera and colleagues point out the limitations of using administrative claims data, some of which we have acknowledged in our article. Despite the inconsistencies and deficiencies in operator identification in the Nationwide Inpatient Sample (NIS) data set, our methodology has been well validated in previous studies. 2,3Among 457 498 PCIs identified in our data set, only 820 procedures (0.2%) were performed in hospitals that reported a single operator. Likewise, the operator volume-outcome relationship did not change in a subgroup analysis by different operator variable identifiers in states that consistently reported unique physician identifiers for the study time period. More than 92% of the procedures identified in our study were listed as primary procedures, highly limiting the possibility of a wrong procedure being linked to the operator.Finally, a direct comparison of median operator volume between NIS and the National Cardiovascular Data Registry (NCDR) CathPCI is not prudent because of differences in representative populations. NIS is designed to approximate a 20% sample of US community hospitals (nonfederal, short-term, general, and specialty), with missing operator volume data on 45% of total PCIs. Registries such as the NCDR CathPCI include operator information for almost all of the PCIs performed in participating hospitals. However, the NIS includes a wealth of administrative data that are not necessarily available in NCDR CathPCI, such as cost of care and concomitant procedures including valvuloplasty and others.The true strength of our study lies in the largest cohort studied to date and reflects the real-world experience of a complex PCI volume-outcome relationship. Our study has greater implications in the current interventional era, where a marked reduction in overall PCI volumes, coupled with a growth of PCI centers in the United States, has led to an overall reduction in PCI procedures at the institutional and operator levels. Indeed, a previous analysis of Medicare fee-forservice PCI data reported that a majority (≈61%) of the operators performed <40 PCIs annually. 4 We believe that administrative data sets (eg, NIS and Centers for Medicare & Medicaid Services data) complement NCDR registries. The linkage of CathPCI and other NCDR registries with longitudinal Centers for Medicare & Medicaid Services data has proven to be a quantum leap in outcomes research. A similar NCDR integration with NIS may offer a multi-insurance outlook. Examination of such administrative data sets provides thought-provoking results that complement the existing literature. The lack of uniform public reporting across the nation will, however, limit the outcomes of any study investigating volume metrics of patient care.We conclude that a strong operator and hospital volume relationship exists in today's world and is backed by preliminary NCDR data. We look forward to further cl...

Background-Safety data on percutaneous left atrial appendage closure arises from centers with considerable expertise in the procedure or from clinical trial, which might not be reproducible in clinical practice. We sought to estimate the frequency and predictors of adverse outcomes and costs of percutaneous left atrial appendage closure procedure in the US. Methods and Results-The