Abstract
BackgroundLittle is known about the utilisation and safety of catheter ablation of atrial fibrillation (AF) among public and private sector hospitals.AimsTo examine the uptake of AF ablations and compare procedural safety between the sectors.Method:Hospitalisation data from all public and private hospitals in four large Australian states (NSW, QLD, VIC and WA) were used to identify patients undergoing AF ablation from 2012 to 17. The primary endpoint was any procedure-related complications up to 30-days post-discharge. Logistic regression was used to evaluate the association between treatment at a public hospital and risk of complications adjusting for covariates.ResultsPrivate hospitals performed most of the 21,654 AF ablations identified (n = 16,992, 78.5 %), on patients who were older (63.5 vs. 59.9y) but had lower rates of heart failure (7.9 % vs. 10.4 %), diabetes (10.2 % vs. 14.1 %), and chronic kidney diseases (2.4 % vs. 5.2 %) (all p < 0.001) than those treated in public hospitals. When compared with private hospitals, public hospitals had a higher crude rate of complications (7.25 % vs. 4.70 %, p < 0.001). This difference remained significant after adjustment (OR 1.74 [95 % CI 1.54–2.04]) and it occurred with both in-hospital (OR 1.83 [1.57–2.14]) and post-discharge (OR 1.39 [1.06–1.83]) complications, with certain complications including acute kidney injury (OR 5.31 [3.02–9.36]), cardiac surgery (OR 5.18 [2.19–12.27]), and pericardial effusion (OR 2.18 [1.50–3.16]).ConclusionsPrivate hospitals performed most of AF ablations in Australia with a lower rate of complications when compared with public hospitals. Further investigations are needed to identify the precise mechanisms of this observed difference.
Highlights
Atrial fibrillation (AF) affects millions of people worldwide and is associated with an increased risk of mortality, morbidity and significant economic burden [1]
Private hospitals performed most of the 21,654 atrial fibrillation (AF) ablations identified (n = 16,992, 78.5 %), on patients who were older (63.5 vs. 59.9y) but had lower rates of heart failure (7.9 % vs. 10.4 %), diabetes (10.2 % vs. 14.1 %), and chronic kidney diseases (2.4 % vs. 5.2 %) than those treated in public hospitals
Private hospitals performed most of AF ablations in Australia with a lower rate of complications when compared with public hospitals
Summary
Atrial fibrillation (AF) affects millions of people worldwide and is associated with an increased risk of mortality, morbidity and significant economic burden [1]. Concerns still exist about procedural safety due to its associated risk of serious complications such as stroke, pericardial effusion or major bleeding [4] Understanding these risks is critical to assist patients and physicians in their discussion regarding AF ablations. Given the rapid dissemination of this procedure, it is imperative to investigate the uptake of AF ablation and whether the safety is comparable in public and private health sectors. This information is important for patients and clinicians in their decision-making process and for hospitals and policy makers seeking to improve care quality. Little is known about the utilisation and safety of catheter ablation of atrial fibrillation (AF) among public and private sector hospitals
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