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Eur J Cardiothorac Surg. 2017 Sep 1;52(3):471-477. doi: 10.1093/ejcts/ezx126.

One-year mortality and costs associated with surgical ablation for atrial fibrillation concomitant to coronary artery bypass grafting.

Author information

1
Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA.
2
Health Sciences West, Scarsdale, NY, USA.
3
Braid-Forbes Health Research, Silver Spring, MD, USA.
4
AtriCure USA.

Abstract

OBJECTIVES:

While surgical ablation (SA) for persistent atrial fibrillation (AF) can reduce recurrence of AF, its impact on longitudinal survival and health-care costs remains controversial. This study defines the clinical outcomes and costs associated with SA in patients with prior AF undergoing coronary artery bypass grafting (CABG).

METHODS:

A total of 3745 Medicare beneficiaries with prior AF who underwent CABG in 2013 were divided into 2 groups: those with and those without concomitant SA. Risk-adjusted early (0-90 days) and late (91-364 days) postoperative outcomes and inpatient costs were compared.

RESULTS:

SA was performed in 17% of CABG patients with prior AF. Preoperative characteristics favoured patients with SA: emergent presentation (15% vs 22%), heart failure in the 2 weeks prior to CABG (31% vs 36%), chronic lung disease (27% vs 33%) and renal failure (4% vs 7%) (all P < 0.05). Risk-adjusted operative mortality and perioperative stroke rates were similar in the 2 groups. Risk-adjusted survival was similar through 90 days, but significantly better with SA after 90 days [hazard ratio (HR) = 0.58; P = 0.03]. At 1 year, the risk-adjusted incidence of cardiovascular implantable electronic device implantation was greater with SA (HR = 1.20; P = 0.01). Risk-adjusted costs for the CABG admission (HR = 1.11; P < 0.01) and inpatient care through 1 year (HR = 1.06; P = 0.02) were also greater with SA.

CONCLUSIONS:

In the US Medicare population, SA was performed in 17% of CABG-AF patients in 2013. Operative risks for mortality and stroke did not increase with SA but costs did. Patients receiving SA, however, had significantly better risk-adjusted late survival.

KEYWORDS:

Atrial ablation ; Atrial fibrillation; Coronary artery bypass grafting; Medicare; Mortality

PMID:
28472412
DOI:
10.1093/ejcts/ezx126
[Indexed for MEDLINE]

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