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Variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in Ontario, Canada
AIMS: Atrial fibrillation (AF) is the most common cardiac rhythm disorder. Emerging evidence supporting the efficacy of catheter ablation in managing AF has led to increased demand for this therapy, potentially outpacing the capacity to perform this procedure. Mismatch between demand and capacity fo...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227764/ https://www.ncbi.nlm.nih.gov/pubmed/36942997 http://dx.doi.org/10.1093/europace/euad074 |
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author | Qeska, Denis Singh, Sheldon M Qiu, Feng Manoragavan, Ragavie Cheung, Christopher C Ko, Dennis T Sud, Maneesh Terricabras, Maria Wijeysundera, Harindra C |
author_facet | Qeska, Denis Singh, Sheldon M Qiu, Feng Manoragavan, Ragavie Cheung, Christopher C Ko, Dennis T Sud, Maneesh Terricabras, Maria Wijeysundera, Harindra C |
author_sort | Qeska, Denis |
collection | PubMed |
description | AIMS: Atrial fibrillation (AF) is the most common cardiac rhythm disorder. Emerging evidence supporting the efficacy of catheter ablation in managing AF has led to increased demand for this therapy, potentially outpacing the capacity to perform this procedure. Mismatch between demand and capacity for AF ablation results in wait-times which have not been comprehensively evaluated at a population level. Additionally, the consequences of such delays in AF ablation, namely the risk of hospitalization or adverse events, have not been studied. METHODS AND RESULTS: This observational cohort study included adults referred for catheter ablation to treat AF in Ontario, Canada, between 1 April 2016 and 31 March 2020. Wait-time was defined from referral to the earliest of ablation, death, off-list, or the study endpoint of 31 March 2022. The outcomes of interest included a composite of death, hospitalization for AF/heart failure, and emergency department visit for AF/heart failure. Our study cohort included 6253 patients referred for de novo AF ablation. The median wait-time for patients who received and who did not receive ablation was 218 days (IQR: 112–363) and 520 days (IQR: 270–763), respectively. Wait-time increased consistently for patients referred between October 2017 and March 2020. Mortality was rare, but significant morbidity was observed, affecting 19.2% of patients on the waitlist for AF ablation. Paroxysmal AF was associated with a statistically significant greater risk for adverse outcomes on the waitlist (HR 1.51, 95% CI 1.18–1.93). CONCLUSION: Wait-times for AF ablation are increasing and are associated with significant morbidity. |
format | Online Article Text |
id | pubmed-10227764 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-102277642023-05-31 Variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in Ontario, Canada Qeska, Denis Singh, Sheldon M Qiu, Feng Manoragavan, Ragavie Cheung, Christopher C Ko, Dennis T Sud, Maneesh Terricabras, Maria Wijeysundera, Harindra C Europace Clinical Research AIMS: Atrial fibrillation (AF) is the most common cardiac rhythm disorder. Emerging evidence supporting the efficacy of catheter ablation in managing AF has led to increased demand for this therapy, potentially outpacing the capacity to perform this procedure. Mismatch between demand and capacity for AF ablation results in wait-times which have not been comprehensively evaluated at a population level. Additionally, the consequences of such delays in AF ablation, namely the risk of hospitalization or adverse events, have not been studied. METHODS AND RESULTS: This observational cohort study included adults referred for catheter ablation to treat AF in Ontario, Canada, between 1 April 2016 and 31 March 2020. Wait-time was defined from referral to the earliest of ablation, death, off-list, or the study endpoint of 31 March 2022. The outcomes of interest included a composite of death, hospitalization for AF/heart failure, and emergency department visit for AF/heart failure. Our study cohort included 6253 patients referred for de novo AF ablation. The median wait-time for patients who received and who did not receive ablation was 218 days (IQR: 112–363) and 520 days (IQR: 270–763), respectively. Wait-time increased consistently for patients referred between October 2017 and March 2020. Mortality was rare, but significant morbidity was observed, affecting 19.2% of patients on the waitlist for AF ablation. Paroxysmal AF was associated with a statistically significant greater risk for adverse outcomes on the waitlist (HR 1.51, 95% CI 1.18–1.93). CONCLUSION: Wait-times for AF ablation are increasing and are associated with significant morbidity. Oxford University Press 2023-03-21 /pmc/articles/PMC10227764/ /pubmed/36942997 http://dx.doi.org/10.1093/europace/euad074 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Clinical Research Qeska, Denis Singh, Sheldon M Qiu, Feng Manoragavan, Ragavie Cheung, Christopher C Ko, Dennis T Sud, Maneesh Terricabras, Maria Wijeysundera, Harindra C Variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in Ontario, Canada |
title | Variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in Ontario, Canada |
title_full | Variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in Ontario, Canada |
title_fullStr | Variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in Ontario, Canada |
title_full_unstemmed | Variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in Ontario, Canada |
title_short | Variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in Ontario, Canada |
title_sort | variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in ontario, canada |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227764/ https://www.ncbi.nlm.nih.gov/pubmed/36942997 http://dx.doi.org/10.1093/europace/euad074 |
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