Catheter Ablation (CA) is an effective treatment for atrial fibrillation (A-Fib). However, elderly frail patients have been understudied due to their exclusion from landmark trials in the past. The national readmission database (2016-2020) was queried, and frailty categories were defined based on hospital risk frailty scores <5 as low and >5 as intermediate-high Mahalanobis Distance Matching was utilized for propensity matching. Pearson's x2 test was applied to the matched cohorts to compare outcomes. Among 55,936 CA hospitalizations for A-Fib, 33,248 patients had low frailty, while 22,628 had intermediate-high frailty. Intermediate-high frailty patients had higher readmissions at 30 (15.5 vs 12.6%), 90 (31.9 vs 25.1%) and 180-day (41 vs 34.7%) intervals [p-value<0.001], higher median length of stay(LOS) (7 vs 3 days) and cost ($44,287 vs $27,517) at index admission [p-value <0.001] and subsequent readmissions [p-value<0.001]. From 2016-2020, median LOS decreased from 3 to 2 in low frailty and 7 to 6 in intermediate-high frailty but total cost increased in both groups [p-value<0.001]. ESRD (aOR: 1.66) and HF (aOR:1.21) were found to be significant predictors of readmission [p-value<0.001] with atrial fibrillation being the most common diagnosis at readmissions (68.6%). Intermediate-high frailty patients undergoing catheter ablation have higher readmission rates and resource utilization at index and readmissions. LOS has decreased in both groups from 2016-2020; however, the total cost has increased.
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Ali et al. (2024) studied this question.
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