Utilization trends of AF ablation among patients with physical disabilities

Abstract Introduction Catheter ablation is an established important treatment for symptomatic atrial fibrillation (AF), and is increasingly being used as a strategy for rhythm control, even among patients that are more difficult to recruit to randomized trials comparing treatment methods in AF. We aimed to assess the utilization trends of AF catheter ablation among patients with physical disabilities, and to evaluate the acute safety of ablation is this population. Methods Using the National Inpatient Sample (NIS) database, patients who underwent AF ablation in the US between 2012 and 2019 were identified using ICD 9/10 codes. Sociodemographic, clinical data, in-hospital procedures and outcomes and length-of-stay (LOS) were collected. Physical disabilities were defined as hearing, visual and speech disabilities along with musculoskeletal disabilities as coded in the registry. Baseline characteristics and in-hospital outcomes were compared between patients with and without physical disabilities. Results An estimated total of 78,190 admissions for AF ablations were performed during the study period. Patients with physical disabilities underwent 1745 AF ablation procedures (2.2%). These patients were older and had more comorbidities, with the exception of diabetes and hypertension. The utilization of AF ablation in physical disability patients increased during the study period from 1.3% of ablations in 2012 and 2013, to over 3% of all AF ablations in 2019. In-hospital complications occurred in 5350 AF procedures, however patients with a disability diagnosis had a higher rates of total in-hospital complications (13.8% vs 6.7%;p<0.001), driven by cardiac complications, stroke (3.4% vs 0.1%;<0.001), vascular and infectious complications (1.4% vs. 0.8%;p=0.007). In-hospital mortality was rare in both groups. Average LOS was nearly a day longer in patients with physical disabilities. Conclusion AF ablation is increasingly utilized in patients with physical disabilities in a nationwide, all-comer registry. This increased trend of ablation procedures, results in a significantly higher complication rates, albeit no change of in-hospital mortality rates. Precautions should be taken to reduce complications in this vulnerable population.AF Ablation annual trend