What does this research mean for the field?

The use of insertable cardiac monitors in patients following atrial fibrillation ablation is associated with fewer severe cardiovascular events and a shift toward routine outpatient management without increasing overall healthcare costs. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 7, 2022Heart Rhythm O2Open Access

Healthcare utilization and clinical outcomes after ablation of atrial fibrillation in patients with and without insertable cardiac monitoring

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Why the study?

Although ICMs increase AF detection and treatment opportunities postablation compared with short-term monitors, healthcare utilization and clinical outcomes in patients with versus without an ICM remained to be examined.

Does insertable cardiac monitoring improve clinical outcomes and healthcare utilization in patients following atrial fibrillation ablation?

Structured PICO

Does insertable cardiac monitoring improve clinical outcomes and healthcare utilization in patients following atrial fibrillation ablation?

Population

3,998 patients with an atrial fibrillation (AF) ablation between January 1, 2011, and March 31, 2018.

Intervention

Insertable cardiac monitor (ICM) implant within 1 year pre- or post-ablation.

Comparator

No insertable cardiac monitor (propensity score matched 1:3).

Outcome

AF-related healthcare utilization, medication use, and occurrence of composite severe cardiovascular events (stroke / transient ischemic attack, major bleeds, systemic embolism, AF- or heart failure–related hospitalization, or death).composite

Insertable cardiac monitoring after AF ablation is associated with fewer severe cardiovascular events and higher rates of oral anticoagulation discontinuation, at similar overall costs.

Implication

ICM after AF ablation was associated with fewer events and lower costs; leaves open confirmation in randomized trials.

Abstract

BackgroundCompared with short-term electrocardiogram (ECG) monitors, insertable cardiac monitors (ICMs) have been shown to increase atrial fibrillation (AF) detection rates and the opportunity to treat recurrent AF in patients postablation.ObjectiveTo examine healthcare utilization and clinical outcomes following AF ablation, in patients with vs without ICM.MethodsRetrospective analysis pooling Optum Clinformatics and Medicare Fee-for-service 5% Sample claims databases. Patients with an AF ablation between January 1, 2011, and March 31, 2018 who received an ICM implant within 1 year pre-/postablation were propensity score matched 1:3 to patients without ICM. Outcomes included AF-related healthcare utilization, medication use, and occurrence of composite severe cardiovascular events (stroke / transient ischemic attack, major bleeds, systemic embolism, AF- or heart failure–related hospitalization, or death).ResultsA total of 1000 ICM patients and 2998 non-ICM patients were included. During mean follow-up of 33 ± 16 months postablation, ICM patients experienced significantly fewer severe cardiovascular events (1.09 ± 2.22 vs 1.37 ± 4.19, P = .008) and associated costs ($20,757 vs $29,106, P = .0005). ICM patients had a greater number of AF-related clinic visits (16.8 vs 11.6 visits, P < .0001) and were more likely to receive a repeat ablation (38.7% vs 32.4%, P = .0003). Total all-cause costs during follow-up were not statistically different. Discontinuation of oral anticoagulation was higher in ICM patients at 1 year (44% vs 31%, P < .0001) and 2 years (73% vs 64%, P = .0012).ConclusionA shift from acute, reactive care to routine outpatient management was observed in patients with long-term ECG monitoring. Results suggest closer patient management in patients with long-term monitoring after an AF ablation and an improvement in outcomes, at similar overall cost. Compared with short-term electrocardiogram (ECG) monitors, insertable cardiac monitors (ICMs) have been shown to increase atrial fibrillation (AF) detection rates and the opportunity to treat recurrent AF in patients postablation. To examine healthcare utilization and clinical outcomes following AF ablation, in patients with vs without ICM. Retrospective analysis pooling Optum Clinformatics and Medicare Fee-for-service 5% Sample claims databases. Patients with an AF ablation between January 1, 2011, and March 31, 2018 who received an ICM implant within 1 year pre-/postablation were propensity score matched 1:3 to patients without ICM. Outcomes included AF-related healthcare utilization, medication use, and occurrence of composite severe cardiovascular events (stroke / transient ischemic attack, major bleeds, systemic embolism, AF- or heart failure–related hospitalization, or death). A total of 1000 ICM patients and 2998 non-ICM patients were included. During mean follow-up of 33 ± 16 months postablation, ICM patients experienced significantly fewer severe cardiovascular events (1.09 ± 2.22 vs 1.37 ± 4.19, P = .008) and associated costs ($20,757 vs $29,106, P = .0005). ICM patients had a greater number of AF-related clinic visits (16.8 vs 11.6 visits, P < .0001) and were more likely to receive a repeat ablation (38.7% vs 32.4%, P = .0003). Total all-cause costs during follow-up were not statistically different. Discontinuation of oral anticoagulation was higher in ICM patients at 1 year (44% vs 31%, P < .0001) and 2 years (73% vs 64%, P = .0012). A shift from acute, reactive care to routine outpatient management was observed in patients with long-term ECG monitoring. Results suggest closer patient management in patients with long-term monitoring after an AF ablation and an improvement in outcomes, at similar overall cost.