Predictors of emergency medical services utilization after different preventive counseling programs in paroxysmal atrial fibrillation patients after catheter ablation

Abstract

Abstract Background Catheter ablation (CA) is known to reduce atrial fibrillation (AF) burden, but even after CA patients (pts) may remain symptomatic and seek for emergency care. Purpose To identify predictors of emergency medical services (EMS) utilization after different preventive counseling programs in paroxysmal AF pts after CA. Methods This is a secondary analysis of a randomized controlled trial in AF pts after CA (radiofrequency or cryoballoon) assessing the effects of a long-term preventive counseling program encompassing remote support. Pts were randomized into 3 groups in 1:1:1 ratio. During hospitalization for CA pts from all groups received single-session preventive counseling with focus on their individual cardiovascular risk factors profile. After discharge, pts from Group 1 received remote preventive counseling by phone and pts from Group 2 by email every two weeks for the first 3 months after enrollment (a total of 6 sessions). Group 3 received usual care. At baseline and at 12 months of follow-up, pts underwent assessments of their demographic parameters (age, sex, education level, marital status, and socioeconomic status) and psychological status (stress level using a 10-point visual analogue scale [VAS] and anxiety and depression by the Hospital Anxiety and Depression Scale [HADS]; transthoracic echocardiography, ECG and 24-hour ECG monitoring. A multivariate regression analysis of seeking for EMS was performed with patients' baseline parameters as independent variables. Results A total of 135 pts aged 35 to 80 years were enrolled (mean age 57.3±9.1 years, 51.8% men). Over 1 year of follow-up, 53 study participants called the ambulance (which made up for 90 calls) with no significant differences between the study groups. Age (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1–2.9; P=0.010), stress level ≥7 points (OR 3.2, 95% CI 1.4–7.5; P=0.007), left ventricular (LV) ejection fraction ≤62% (OR 2.6, 95% CI 1.1–6.1; P=0.024); and left atrial (LA) diameter ≥42 mm (OR 3.6, 95% CI 1.5–8.5; P=0.003) were independent predictors of an EMS call. Conclusions Age, perceived stress level, reduced LV function and LA size were independent predictors of EMS utilization after CA regardless of preventive counseling interventions. Funding Acknowledgement Type of funding source: None