Sex-based differences in outcomes, 30-day readmissions, and costs following catheter ablation of atrial fibrillation: the United States Nationwide Readmissions Database 2010–14
Abstract Aims Although catheter ablation has emerged as an important therapy for patients with symptomatic atrial fibrillation (AF), there are limited data on sex-based differences in outcomes. We sought to compare in-hospital outcomes and 30-day readmissions of women and men undergoing AF ablation....
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| Veröffentlicht in: | European heart journal 2019-09, Vol.40 (36), p.3035-3043 |
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| container_title | European heart journal |
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| creator | Cheung, Jim W Cheng, Edward P Wu, , Xian Yeo, Ilhwan Christos, Paul J Kamel, Hooman Markowitz, Steven M Liu, Christopher F Thomas, George Ip, James E Lerman, Bruce B Kim, Luke K |
| description | Abstract
Aims
Although catheter ablation has emerged as an important therapy for patients with symptomatic atrial fibrillation (AF), there are limited data on sex-based differences in outcomes. We sought to compare in-hospital outcomes and 30-day readmissions of women and men undergoing AF ablation.
Methods and results
Using the United States Nationwide Readmissions Database, we analysed patients undergoing AF ablation between 2010 and 2014. Based on ICD-9-CM codes, we identified co-morbidities and outcomes. Multivariable logistic regression and inverse probability-weighting analysis were performed to assess female sex as a predictor of endpoints. Of 54 597 study patients, 20 623 (37.7%) were female. After adjustment for age, co-morbidities, and hospital factors, women had higher rates of any complication [adjusted odds ratio (aOR) 1.39; P |
| doi_str_mv | 10.1093/eurheartj/ehz151 |
| format | Article |
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Aims
Although catheter ablation has emerged as an important therapy for patients with symptomatic atrial fibrillation (AF), there are limited data on sex-based differences in outcomes. We sought to compare in-hospital outcomes and 30-day readmissions of women and men undergoing AF ablation.
Methods and results
Using the United States Nationwide Readmissions Database, we analysed patients undergoing AF ablation between 2010 and 2014. Based on ICD-9-CM codes, we identified co-morbidities and outcomes. Multivariable logistic regression and inverse probability-weighting analysis were performed to assess female sex as a predictor of endpoints. Of 54 597 study patients, 20 623 (37.7%) were female. After adjustment for age, co-morbidities, and hospital factors, women had higher rates of any complication [adjusted odds ratio (aOR) 1.39; P < 0.0001], cardiac perforation (aOR 1.39; P = 0.006), and bleeding/vascular complications (aOR 1.49; P < 0.0001). Thirty-day all-cause readmission rates were higher for women compared to men (13.4% vs. 9.4%; P < 0.0001). Female sex was independently associated with readmission for AF/atrial tachycardia (aOR 1.48; P < 0.0001), cardiac causes (aOR 1.40; P < 0.0001), and all causes (aOR 1.25; P < 0.0001). Similar findings were confirmed with inverse probability-weighting analysis. Despite increased complications and readmissions, total costs for AF ablation were lower for women than men due to decreased resource utilization.
Conclusions
Independent of age, co-morbidities, and hospital factors, women have higher rates of complications and readmissions following AF ablation. Sex-based differences and disparities in the management of AF need to be explored to address these gaps in outcomes.]]></description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehz151</identifier><identifier>PMID: 30927423</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Atrial Fibrillation - epidemiology ; Atrial Fibrillation - surgery ; Catheter Ablation - adverse effects ; Catheter Ablation - economics ; Clinical Research ; Databases, Factual ; Female ; Heart Injuries - epidemiology ; Hemorrhage - epidemiology ; Humans ; Male ; Patient Readmission - statistics & numerical data ; Postoperative Complications - epidemiology ; Sex Distribution ; Tachycardia - epidemiology ; United States - epidemiology</subject><ispartof>European heart journal, 2019-09, Vol.40 (36), p.3035-3043</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com. 2019</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c498t-6f6fe940d17458dbe98a4dbd3461acc8b132bce7e3de89e5fad4cdfefa80f14e3</citedby><cites>FETCH-LOGICAL-c498t-6f6fe940d17458dbe98a4dbd3461acc8b132bce7e3de89e5fad4cdfefa80f14e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,1578,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30927423$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cheung, Jim W</creatorcontrib><creatorcontrib>Cheng, Edward P</creatorcontrib><creatorcontrib>Wu, , Xian</creatorcontrib><creatorcontrib>Yeo, Ilhwan</creatorcontrib><creatorcontrib>Christos, Paul J</creatorcontrib><creatorcontrib>Kamel, Hooman</creatorcontrib><creatorcontrib>Markowitz, Steven M</creatorcontrib><creatorcontrib>Liu, Christopher F</creatorcontrib><creatorcontrib>Thomas, George</creatorcontrib><creatorcontrib>Ip, James E</creatorcontrib><creatorcontrib>Lerman, Bruce B</creatorcontrib><creatorcontrib>Kim, Luke K</creatorcontrib><title>Sex-based differences in outcomes, 30-day readmissions, and costs following catheter ablation of atrial fibrillation: the United States Nationwide Readmissions Database 2010–14</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description><![CDATA[Abstract
Aims
Although catheter ablation has emerged as an important therapy for patients with symptomatic atrial fibrillation (AF), there are limited data on sex-based differences in outcomes. We sought to compare in-hospital outcomes and 30-day readmissions of women and men undergoing AF ablation.
Methods and results
Using the United States Nationwide Readmissions Database, we analysed patients undergoing AF ablation between 2010 and 2014. Based on ICD-9-CM codes, we identified co-morbidities and outcomes. Multivariable logistic regression and inverse probability-weighting analysis were performed to assess female sex as a predictor of endpoints. Of 54 597 study patients, 20 623 (37.7%) were female. After adjustment for age, co-morbidities, and hospital factors, women had higher rates of any complication [adjusted odds ratio (aOR) 1.39; P < 0.0001], cardiac perforation (aOR 1.39; P = 0.006), and bleeding/vascular complications (aOR 1.49; P < 0.0001). Thirty-day all-cause readmission rates were higher for women compared to men (13.4% vs. 9.4%; P < 0.0001). Female sex was independently associated with readmission for AF/atrial tachycardia (aOR 1.48; P < 0.0001), cardiac causes (aOR 1.40; P < 0.0001), and all causes (aOR 1.25; P < 0.0001). Similar findings were confirmed with inverse probability-weighting analysis. Despite increased complications and readmissions, total costs for AF ablation were lower for women than men due to decreased resource utilization.
Conclusions
Independent of age, co-morbidities, and hospital factors, women have higher rates of complications and readmissions following AF ablation. Sex-based differences and disparities in the management of AF need to be explored to address these gaps in outcomes.]]></description><subject>Aged</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Catheter Ablation - adverse effects</subject><subject>Catheter Ablation - economics</subject><subject>Clinical Research</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Heart Injuries - epidemiology</subject><subject>Hemorrhage - epidemiology</subject><subject>Humans</subject><subject>Male</subject><subject>Patient Readmission - statistics & numerical data</subject><subject>Postoperative Complications - epidemiology</subject><subject>Sex Distribution</subject><subject>Tachycardia - epidemiology</subject><subject>United States - epidemiology</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1u1TAQhS0EopfCnhXyEglC7dhJHBZIqPxKFUiUSuysiT3udZUbX2yHUla8A2_CI_EkuKRclRUrSzPfnDPjQ8h9zp5w1osDnOMaIeazA1x_4w2_QVa8qeuqb2Vzk6wY75uqbdWnPXInpTPGmGp5e5vsCdbXnazFivw8xq_VAAkttd45jDgZTNRPNMzZhA2mx1SwysIFjQh241PyYSpFmCw1IeVEXRjHcO6nU2ogrzFjpDCMkAtHg6OQo4eROj9EPy7lp7Rw9GTyudgeZ8jF8d2fzrm3SD9cM6IvIMPlfrRmnP36_oPLu-SWgzHhvat3n5y8evnx8E119P7128PnR5WRvcpV61qHvWSWd7JRdsBegbSDFbLlYIwauKgHgx0Ki6rHxoGVxjp0oJjjEsU-ebbobudhg9bglCOMehv9BuKFDuD1v53Jr_Vp-KK7vhVcqCLw8Eoghs8zpqzLVQbLJ0wY5qTrmrFOiaZhBWULamJIKaLb2XCmL6PWu6j1EnUZeXB9vd3A32wL8GgBwrz9v9xvZ5m-gg</recordid><startdate>20190921</startdate><enddate>20190921</enddate><creator>Cheung, Jim W</creator><creator>Cheng, Edward P</creator><creator>Wu, , Xian</creator><creator>Yeo, Ilhwan</creator><creator>Christos, Paul J</creator><creator>Kamel, Hooman</creator><creator>Markowitz, Steven M</creator><creator>Liu, Christopher F</creator><creator>Thomas, George</creator><creator>Ip, James E</creator><creator>Lerman, Bruce B</creator><creator>Kim, Luke K</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190921</creationdate><title>Sex-based differences in outcomes, 30-day readmissions, and costs following catheter ablation of atrial fibrillation: the United States Nationwide Readmissions Database 2010–14</title><author>Cheung, Jim W ; Cheng, Edward P ; Wu, , Xian ; Yeo, Ilhwan ; Christos, Paul J ; Kamel, Hooman ; Markowitz, Steven M ; Liu, Christopher F ; Thomas, George ; Ip, James E ; Lerman, Bruce B ; Kim, Luke K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c498t-6f6fe940d17458dbe98a4dbd3461acc8b132bce7e3de89e5fad4cdfefa80f14e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Catheter Ablation - adverse effects</topic><topic>Catheter Ablation - economics</topic><topic>Clinical Research</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Heart Injuries - epidemiology</topic><topic>Hemorrhage - epidemiology</topic><topic>Humans</topic><topic>Male</topic><topic>Patient Readmission - statistics & numerical data</topic><topic>Postoperative Complications - epidemiology</topic><topic>Sex Distribution</topic><topic>Tachycardia - epidemiology</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cheung, Jim W</creatorcontrib><creatorcontrib>Cheng, Edward P</creatorcontrib><creatorcontrib>Wu, , Xian</creatorcontrib><creatorcontrib>Yeo, Ilhwan</creatorcontrib><creatorcontrib>Christos, Paul J</creatorcontrib><creatorcontrib>Kamel, Hooman</creatorcontrib><creatorcontrib>Markowitz, Steven M</creatorcontrib><creatorcontrib>Liu, Christopher F</creatorcontrib><creatorcontrib>Thomas, George</creatorcontrib><creatorcontrib>Ip, James E</creatorcontrib><creatorcontrib>Lerman, Bruce B</creatorcontrib><creatorcontrib>Kim, Luke K</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cheung, Jim W</au><au>Cheng, Edward P</au><au>Wu, , Xian</au><au>Yeo, Ilhwan</au><au>Christos, Paul J</au><au>Kamel, Hooman</au><au>Markowitz, Steven M</au><au>Liu, Christopher F</au><au>Thomas, George</au><au>Ip, James E</au><au>Lerman, Bruce B</au><au>Kim, Luke K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sex-based differences in outcomes, 30-day readmissions, and costs following catheter ablation of atrial fibrillation: the United States Nationwide Readmissions Database 2010–14</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2019-09-21</date><risdate>2019</risdate><volume>40</volume><issue>36</issue><spage>3035</spage><epage>3043</epage><pages>3035-3043</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract><![CDATA[Abstract
Aims
Although catheter ablation has emerged as an important therapy for patients with symptomatic atrial fibrillation (AF), there are limited data on sex-based differences in outcomes. We sought to compare in-hospital outcomes and 30-day readmissions of women and men undergoing AF ablation.
Methods and results
Using the United States Nationwide Readmissions Database, we analysed patients undergoing AF ablation between 2010 and 2014. Based on ICD-9-CM codes, we identified co-morbidities and outcomes. Multivariable logistic regression and inverse probability-weighting analysis were performed to assess female sex as a predictor of endpoints. Of 54 597 study patients, 20 623 (37.7%) were female. After adjustment for age, co-morbidities, and hospital factors, women had higher rates of any complication [adjusted odds ratio (aOR) 1.39; P < 0.0001], cardiac perforation (aOR 1.39; P = 0.006), and bleeding/vascular complications (aOR 1.49; P < 0.0001). Thirty-day all-cause readmission rates were higher for women compared to men (13.4% vs. 9.4%; P < 0.0001). Female sex was independently associated with readmission for AF/atrial tachycardia (aOR 1.48; P < 0.0001), cardiac causes (aOR 1.40; P < 0.0001), and all causes (aOR 1.25; P < 0.0001). Similar findings were confirmed with inverse probability-weighting analysis. Despite increased complications and readmissions, total costs for AF ablation were lower for women than men due to decreased resource utilization.
Conclusions
Independent of age, co-morbidities, and hospital factors, women have higher rates of complications and readmissions following AF ablation. Sex-based differences and disparities in the management of AF need to be explored to address these gaps in outcomes.]]></abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>30927423</pmid><doi>10.1093/eurheartj/ehz151</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged Atrial Fibrillation - epidemiology Atrial Fibrillation - surgery Catheter Ablation - adverse effects Catheter Ablation - economics Clinical Research Databases, Factual Female Heart Injuries - epidemiology Hemorrhage - epidemiology Humans Male Patient Readmission - statistics & numerical data Postoperative Complications - epidemiology Sex Distribution Tachycardia - epidemiology United States - epidemiology |
| title | Sex-based differences in outcomes, 30-day readmissions, and costs following catheter ablation of atrial fibrillation: the United States Nationwide Readmissions Database 2010–14 |
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