Association of Atrial Ablation Procedure and Palliative Care for High-Risk Mortality Group With Atrial Fibrillation in U.S. Hospitals: 2016-2021 National Inpatient Sample Analysis

ObjectivesRecently, atrial fibrillation (AF) has contributed to an increase in cardiovascular deaths in the U.S. Palliative care (PC) and atrial ablation (AA) procedure can elevate quality of life of high-risk AF patients, who are associated with multiple comorbidities. We explore the combined PC and AA management among high-risk mortality groups with AF.MethodsThis pooled cross-sectional retrospective data used the National Inpatient Sample (2016-2021) and included national estimates of 2,965,334 hospital discharges in the high-risk mortality group with AF. Multivariable regression was performed to determine the factors associated with AA procedure and PC centered on CHA2DS2-VASc score, systolic heart failure, and in-hospital mortality. Race/ethnicity, health insurance, and hospital location were controlled in multivariable analyses.ResultsPalliative care utilization was on an uptrend from 9.02% in 2016 to 12.29% in 2021. Factors that were negatively associated with PC utilization were increasing CHA2-DS2-VASc score (OR = 0.878), systolic heart failure (OR = 0.976), AA procedure (OR = 0.287), racial minorities, and rural residents. Atrial ablation was positively associated with systolic heart failure (OR = 2.920) and was negatively associated with increasing CHA2-DS2-VASc score (OR = 0.951) and PC utilization (OR = 0.283). Racial minorities and rural residents were less likely to receive AA procedure.ConclusionsPalliative care utilization was associated with lower probability of AA procedures by approximately 75%, and vice versa. Atrial ablation procedures and PC utilization were discrete choice patterns indicating healthcare providers' tendency to favor the status quo and current practices rather than initiating change. Health disparities in PC utilization and AA procedures were identified in racial minorities and rural residents. Call to action is warranted to increase PC awareness and harmonious approach of PC and AA procedure for those with high-risk mortality AF patients in the U.S. hospitals.