Real-world characteristics and readmissions among patients undergoing ablation for ventricular tachycardia: a retrospective database analysis of commercially insured patients in the USA

Abstract

BackgroundRadiofrequency catheter ablation is an effective treatment to alleviate symptoms and reduce recurrent implantable cardioverter-defibrillator (ICD/CRT-D) shocks in patients with ventricular tachycardia (VT).ObjectiveTo assess the characteristics and outcomes (complications, inpatient readmissions) of commercially insured patients in the USA undergoing ablation for ischaemic or non-ischaemic VT.MethodsPatients aged 18–64 years with a primary diagnosis of VT who underwent ablation between 2006 and 2015 were identified using the IBM MarketScan Commercial Database. The rate of complications including vascular complications, pericarditis, pulmonary embolism and pericardial tamponade over a 30-day post-ablation period (including index admission) was examined. Inpatient readmissions (VT-related, heart failure (HF)-related and non-VT arrhythmia-related) over the 12-month post-ablation period were examined. A Cox regression model was used to determine factors associated with inpatient readmissions.Results5242 patients (488 with ischaemic and 4754 with non-ischaemic VT) met the study criteria. The majority of VT ablations occurred in an outpatient setting (57% for ischaemic and 66% for non-ischaemic VT). Among complications, vascular complications were most frequent (2.05% among ischaemic and 1.6% among non-ischaemic VT patients) over the 30-day post-ablation period. Among ischaemic VT patients, 17%, 7.6% and 4.7% had VT-related, HF-related and non-VT arrhythmia-related inpatient readmissions, respectively in the 12-month post-ablation period. For non-ischaemic VT patients, these numbers were 7.5%, 1.7% and 3.1%, respectively. Inpatient setting (vs outpatient), baseline ICD/CRT-D implantation, HF comorbidity and ≥2 prior hospitalisations were associated with a higher risk of post-ablation VT-related inpatient readmissions among ischaemic VT patients. Similar factors also were associated with a higher risk of post-ablation VT-related inpatient readmission among non-ischaemic VT patients.ConclusionSetting of ablation and comorbidity status were found to influence readmission rates. Complication and readmission rates following VT ablation were low indicating towards the favourable safety profile of VT ablation.

A real-world analysis of the effectiveness, resource use, and costs associated with ventricular tachycardia catheter ablation in Japanese patients aged ≤75 years

“…One-year freedom from VT-related readmissions (79.0%) was lower than a US study stratifying ischemic (83.0%) and nonischemic (92.5%) patients. 8 However, 1-year freedom from all-cause readmission (67.1%) was similar to the THERMOCOOL® postapproval VT trial (69.3%). 2 …”

“…One-year freedom from VT-related readmissions (79.0%) was lower than a US study stratifying ischemic (83.0%) and nonischemic (92.5%) patients. 8 However, one-year J o u r n a l P r e -p r o o f freedom from all-cause readmission (67.1%) was similar to the THERMOCOOL ® postapproval VT trial (69.3%). 2 Eliminating VT in a single procedure may have significant ramifications for healthcare systems by preventing downstream economic impact.…”

Race, Sex, and Neighborhood Socioeconomic Disparities in Ablation of Ventricular Tachycardia Within a National Medicare Cohort

“…Approximately 60% to 65% of VT ablations may be performed as an outpatient or with outpatient short‐stay hospitalizations. 12 Because our data set does not include procedures performed as an outpatient, these results may not reflect referral patterns for outpatient VT ablation. Although this study only includes ablation performed during hospitalization, we believe that investigating ablation on hospitalized patients with VT who are often critically ill with a high acuity facilitates investigation of socioeconomic disparities in delivery of electrophysiologic care.…”

“…This study is a retrospective analysis of the 100% national Medicare fee‐for‐service inpatient claims data set from 2013 to 2014. Patients were included in the analysis if they were aged >18 years and admitted to an acute care hospital from January 1, 2014, through November 30, 2014, with VT, identified using International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD‐9‐CM ) code 427.1x in any position, 11 , 12 had a valid ZIP+4 code to allow geolinking, and were continuously enrolled in Medicare Part A and B in the year before the index hospitalization. To ensure completeness of claims information, patients were excluded if they were beneficiaries of the Railroad Retirement program or if they were enrolled in a health maintenance organization (Medicare Advantage plan).…”

“…The outcome was endovascular ablation ( ICD‐9‐CM procedure code 37.34) performed during the index hospitalization. 11 , 12 …”