Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, MA, 02215, USA.
Medical Device Epidemiology and Real World Data Science, Johnson and Johnson, New Brunswick, NJ, USA.
BMC Cardiovasc Disord. 2020 Apr 6;20(1):161. doi: 10.1186/s12872-020-01446-9.
Catheter ablation (CA) has emerged as an effective treatment for symptomatic atrial fibrillation (AF). However practice patterns and patient factors associated with referral for CA within the first 12 months after diagnosis are poorly characterized. This study examined overall procedural trends and factors predictive of catheter ablation for newly-diagnosed atrial fibrillation in a young, commercially-insured population.
A large nationally-representative sample of patients age 20 to 64 from years 2010 to 2016 was studied using the IBM MarketScan® Commercial Database. Patients were included with a new diagnosis of AF in the inpatient or outpatient setting with continuous enrollment for at least 1 year pre and post index visit. Patients were excluded if they had prior history of AF or had filled an anti-arrhythmic drug (AAD) in the pre-index period.
Early CA increased from 5.0% in 2010 to 10.5% in 2016. Patients were less likely to undergo CA if they were located in the Northeast (OR: 0.80, CI: 0.73-0.88) or North Central (OR: 0.91, CI: 0.83-0.99) regions (compared with the West), had higher CHADS-VASc scores, or had Charlson Comorbidity Index (CCI) score of 3 or greater (OR: 0.61; CI: 0.51-0.72).
CA within 12 months for new-diagnosed AF increased significantly from 2010 to 2016, with most patients still trialed on an AAD prior to CA. Patients are less likely to be referred for early CA if they are located in the Northeast and North Central regions, have more comorbidities, or higher CHADS-VASc scores.
导管消融（CA）已成为治疗有症状的心房颤动（AF）的有效方法。然而，在诊断后 12 个月内，与推荐 CA 相关的实践模式和患者因素尚未得到充分描述。本研究检查了在年轻的商业保险人群中，新诊断的心房颤动患者接受导管消融的总体治疗趋势和预测因素。
利用 IBM MarketScan®商业数据库，对 2010 年至 2016 年期间年龄在 20 至 64 岁的患者进行了一项大型全国代表性样本研究。在门诊或住院环境中，对具有新诊断 AF 的患者进行研究，患者在指数就诊前和就诊后至少有 1 年的连续入组。如果患者有既往 AF 病史或在指数就诊前的预索引期内服用过抗心律失常药物（AAD），则将其排除在外。
早期 CA 从 2010 年的 5.0%增加到 2016 年的 10.5%。如果患者位于东北部（OR：0.80，95%CI：0.73-0.88）或中北部（OR：0.91，95%CI：0.83-0.99）地区（与西部地区相比），CHADS-VASc 评分较高，或 Charlson 合并症指数（CCI）评分≥3（OR：0.61；95%CI：0.51-0.72），则不太可能接受 CA。
新诊断的 AF 在 12 个月内接受 CA 的比例从 2010 年至 2016 年显著增加，大多数患者在 CA 前仍尝试使用 AAD。如果患者位于东北部和中北部地区，合并症较多，或 CHADS-VASc 评分较高，则不太可能被推荐进行早期 CA。
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