PO-682-06 INCREASING NUMBER OF CATHETER ABLATIONS IS ASSOCIATED WITH INCREASED LONG TERM HEALTH CARE RESOURCE UTILIZATION: A PROPENSITY MATCHED ANALYSIS

Abstract

For patients who receive catheter ablation for ventricular tachycardia (VT), approximately one-third of patients may require more than one VT ablation. While the risk factors for repeat catheter ablation have been previously described, longer term outcomes and health care utilization differences are not as well characterized. To determine health care utilization and cost differences following one versus more than one catheter ablation for VT in a single year. VT patients who underwent catheter ablation during an index year (October 2016 to October 2017) were identified in the Medicare Standard Analytic File. Patients were categorized by having only one versus more than one catheter ablation during the index year. Inpatient and outpatient claims were compared in the year prior through two years after the index year. A propensity matched analysis was used to compare resource utilization endpoints and survival. 3,730 patients had one catheter ablation (CA1) and 441 received > 1 procedure (CA2+). CA2+ patients were younger and less likely to have treatment as an outpatient (27% versus 32%, p<0.02). After propensity matching, there was no difference in mortality between the two groups. However, in the two years following treatment, CA2+ patients had significantly more 30-day readmissions from the procedure (34% versus 16%, p<0.01), emergency department visits (3.8 versus 2.8, p<0.01), inpatient admissions (85% versus 60%, p<0.01), and length of stay during admissions (23 days versus 16, p<0.01). The 2-year post-index period showed significantly higher median Medicare costs for outpatient and inpatient services for the CA2+group ($75,344 versus $39,100, p<0.01). Patients who received more than one catheter ablation for VT in an index year had significantly increased rates of inpatient health care utilization and associated costs. Patients requiring repeat catheter ablation in a short time frame may benefit from closer clinical monitoring to prevent repeat hospitalizations. Development of more effective and less risky salvage therapies may favorably alter the trajectory of health care resource utilization.