Outcomes and Resource Utilization Associated With Readmissions After Atrial Fibrillation Hospitalizations

Abstract

BackgroundAtrial fibrillation is the most common arrhythmia worldwide. Data regarding 30‐day readmission rates after discharge for atrial fibrillation remain poorly reported.Methods and ResultsThe Nationwide Readmission Database (2010–2014) was queried using the International Classification of Diseases, Ninth Revision (ICD‐9) codes to identify study population. Incidence, etiologies of 30‐day readmission and predictors of 30‐day readmissions, and cost of care were analyzed. Among 1 723 378 patients who survived to discharge, 249 343 (14.4%) patients were readmitted within 30 days. Compared with the readmitted group, the nonreadmitted group had higher utilization of electrical cardioversion and catheter ablation. Atrial fibrillation was the most common cause of readmission (24.1%). Median time to 30‐day readmission was 13 days. Advancing age, female sex, and longer stay during index hospitalization predicted higher 30‐day readmissions, whereas private insurance, electrical cardioversion, catheter ablation, higher income, and elective admissions correlated with lower 30‐day readmission. Comorbidities such as heart failure, neurological disorder, chronic obstructive pulmonary disease, diabetes mellitus, chronic kidney disease, chronic liver failure, coagulopathy, anemia, peripheral vascular disease, and electrolyte disturbance, correlated with increased 30‐day readmissions and cost burden. Trend analysis showed a progressive decline in 30‐day readmission rates from 14.7% in 2010 to 14.3% in 2014 (P trend, <0.001).ConclusionsApproximately 1 in 7 patients were readmitted within 30 days of discharge, with symptomatic atrial fibrillation being the most common cause. We identified a predictive model for increased risk of readmissions and treatment expense. Electrical cardioversion during index admission was associated with a significant reduction in 30‐day readmissions and service charges. The 30‐day readmissions correlated with a substantial rise in the cost of care.

Thirty‐day readmissions after atrial fibrillation catheter ablation in patients with heart failure

“…This has brought about the development of programs such as the Affordable Care Act's Hospital Readmissions Reduction Program aimed at reducing unplanned readmissions 21‐23 . The observed 30‐day readmission rates in our study are considerable, and similar to those seen for HF (21.4%) 20 and AF (14.3%) 14 in the general population. A previous study from Elkaryoni et al utilizing the 2010‐2015 NRD found among patients with HF the rate of 30‐day readmission was 44.9% before and 31.9% after CA ( P < .00) 15 .…”

“…To the best of our knowledge, this study is the first to examine patients with HF and AF undergoing CA on a nationwide basis with ICD‐10‐CM coding. The use of ICD‐10‐CM coding provides significant benefit in disease diagnosis and procedural specificity over the ICD‐9‐CM coding system, which prior studies have used 5,12‐15 . Moreover, throughout the last decade, the technology and treatment modalities of AF CA have considerably changed, thus limiting interpretation of older studies.…”

Short‐term outcomes associated with ventricular tachycardia catheter ablation—Reply to the letter

“…In our study, we noted that approximately 43% of patients admitted for VT ablation had coexisting heart failure 1 . It has been reported that coexisting comorbidities are most frequent primary diagnosis during rehospitalizations 2‐5 . So it is not surprising to see that paroxysmal VT and heart failure were two most common readmitting diagnoses.…”

Short‐term outcomes associated with inpatient ventricular tachycardia catheter ablation

“…We identified in total 11 725 index admissions. Similar methods were used previously 12–16 . Patients who were readmitted to the hospital within 30 days within the same calendar year were further evaluated (n = 1911).…”