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J Thorac Cardiovasc Surg. 2019 Sep 10. pii: S0022-5223(19)31755-6. doi: 10.1016/j.jtcvs.2019.07.131. [Epub ahead of print]

Surgical ablation of atrial fibrillation concomitant to coronary-artery bypass grafting provides cost-effective mortality reduction.

Author information

1
Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa. Electronic address: jsrankinmd@cs.com.
2
Health Sciences West, Scarsdale, NY; Braid-Forbes Health Research, Silver Spring, Md.
3
Braid-Forbes Health Research, Silver Spring, Md.
4
Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.

Abstract

BACKGROUND:

Data on the longitudinal impact of surgical ablation (SA) for atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting (CABG) remain limited. This study examined 2-year risk-adjusted mortality and total hospital costs in Medicare beneficiaries with AF requiring CABG with or without SA.

METHODS:

CABG was performed in 3745 Medicare beneficiaries with AF in 2013, with concomitant SA in 17% (626 of 3745). Risk-adjusted mortality, morbidity, and cost during the first 2 postoperative years for patients with SA and those without SA were compared. A piecewise Cox proportional hazard model (0-90 days and 91-729 days) was used to risk-adjust mortality.

RESULTS:

Compared with the no SA group, the SA group had lower rates of heart failure before surgery (31% vs 36%), chronic lung disease (27% vs 33%), renal failure (4% vs 7%), and urgent or emergent presentation (34% vs 49%) (all P < .05). Risk-adjusted index admission costs were higher with SA (rate ratio [RR], 1.11; P < .01), as were readmissions for AF (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.00-1.29; P = .04) and pacemaker/defibrillator implantation (HR, 1.37; 95%, 1.08-1.74; P = .01). Risk-adjusted inpatient days and inpatient costs were similar after 2 years (RR, 0.97; P = .31 and RR = 1.04; P = .17, respectively); however, the risk-adjusted hazard for late mortality (91-729 days) was significantly lower with SA (HR, 0.71; 95% CI, 0.52-0.97; P = .03).

CONCLUSIONS:

In patients with AF requiring CABG, SA was associated with a 29% lower risk-adjusted hazard for late mortality. Index hospital costs were higher with SA, but total inpatient costs were not different in the 2 groups after 2 years. SA appears to be a cost-effective intervention to enhance late 2-year survival in patients with AF undergoing CABG.

KEYWORDS:

atrial fibrillation; coronary artery bypass grafting; surgical ablation

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