Sheldon M Singh1, Lauren Webster2, Dennis T Ko3, Jack V Tu3, Harindra C Wijeysundera3. 1. Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: sheldon.singh@sunnybrook.ca. 2. Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada. 3. Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Abstract
OBJECTIVES: This study sought to determine factors associated with cardiac electrophysiologist assessment and atrial fibrillation (AF) ablation in patients with new-onset AF. BACKGROUND: Factors driving variation in the use of AF ablation have not been well described. METHODS: All individuals with new-onset AF in Ontario, Canada, between January 1, 2010, and December 31, 2012, were identified. Survival analysis accounting for the competing risk of death was used to evaluate the association between clinical and nonclinical factors and receipt of an electrophysiologist assessment. Factors associated with AF ablation were then determined in the subgroup of patients who received an electrophysiologist assessment. RESULTS: A total of 22,032 patients with new-onset AF were identified, 8,161 (37%) of whom received an electrophysiology assessment. Prior cardiologist care was associated with electrophysiologist assessment (hazard ratio [HR]: 1.57; p < 0.0001). Rural residence was associated with a decreased incidence of electrophysiology assessment (HR: 0.80; p < 0.0001). A total of 424 (5.2%) patients receiving an electrophysiologist assessment had an AF ablation. Recurrent AF emergency department (ED) visits between the index ED visit and the initial electrophysiologist assessment (HR for ≥2 ED visits: 4.22; p < 0.0001) and rural residence (HR: 1.50; p = 0.002) were both associated with AF ablation. Cardiovascular comorbidities were associated with a decreased incidence of AF ablation. CONCLUSIONS: Rural patients with AF have a lower incidence of electrophysiologist assessment but paradoxically a higher incidence of AF ablation compared with their urban counterparts. Clinical factors such as recurrent ED visits for AF and cardiovascular comorbidities are the most important factors associated with of AF ablation.
OBJECTIVES: This study sought to determine factors associated with cardiac electrophysiologist assessment and atrial fibrillation (AF) ablation in patients with new-onset AF. BACKGROUND: Factors driving variation in the use of AF ablation have not been well described. METHODS: All individuals with new-onset AF in Ontario, Canada, between January 1, 2010, and December 31, 2012, were identified. Survival analysis accounting for the competing risk of death was used to evaluate the association between clinical and nonclinical factors and receipt of an electrophysiologist assessment. Factors associated with AF ablation were then determined in the subgroup of patients who received an electrophysiologist assessment. RESULTS: A total of 22,032 patients with new-onset AF were identified, 8,161 (37%) of whom received an electrophysiology assessment. Prior cardiologist care was associated with electrophysiologist assessment (hazard ratio [HR]: 1.57; p < 0.0001). Rural residence was associated with a decreased incidence of electrophysiology assessment (HR: 0.80; p < 0.0001). A total of 424 (5.2%) patients receiving an electrophysiologist assessment had an AF ablation. Recurrent AF emergency department (ED) visits between the index ED visit and the initial electrophysiologist assessment (HR for ≥2 ED visits: 4.22; p < 0.0001) and rural residence (HR: 1.50; p = 0.002) were both associated with AF ablation. Cardiovascular comorbidities were associated with a decreased incidence of AF ablation. CONCLUSIONS: Rural patients with AF have a lower incidence of electrophysiologist assessment but paradoxically a higher incidence of AF ablation compared with their urban counterparts. Clinical factors such as recurrent ED visits for AF and cardiovascular comorbidities are the most important factors associated with of AF ablation.
Authors: Konsta Teppo; Jussi Jaakkola; Fausto Biancari; Olli Halminen; Miika Linna; Jari Haukka; Jukka Putaala; Pirjo Mustonen; Janne Kinnunen; Alex Luojus; Saga Itäinen-Strömberg; Juha Hartikainen; Aapo L Aro; K E Juhani Airaksinen; Mika Lehto Journal: Int J Environ Res Public Health Date: 2022-09-06 Impact factor: 4.614