ABC | Volume 113, Nº2, August 2019

Original Article Saad et al. Healthcare utilization and costs after ablation for AF Arq Bras Cardiol. 2019; 113(2):252-257 Figure 1 – Flow chart of patient selection 179 eligible patients submitted to ablation procedures with an ICD code of I 48 96 patients excluded • Available follow-up time below 3 months, either before or after ablation (n = 49) • Non-elective procedure (n = 22) • Lack of three-dimensional electrophysiologic mapping (n = 15) • PVAC catheter (n = 6) • Age below 18 (n = 2) • Ablation with technique not involving radiofrequency (n = 1) • Previous ablation procedure (n = 1) 83 patients included Table 1 – Demographics and perioperative information of study patients Variable Total (%) Male gender 58 (69.9) Age* 52.8 (14.6) Comorbidities Hypertension 15 (18) Heart failure 5 (6) Ischemic heart disease 10 (12) Valvular heart disease 4 (4.8) Conduction system disease 3 (3.6) Diabetes 4 (4.8) Sleep apnea 7 (8.49) Thyreoid disease 5 (6) Pre-procedural follow-up time (months)* 14.4 (7.2) Post-procedural follow-up time (months)* 10.9 (5.4) Prucedural LOS (days)* 1.93 (1.6) Catheter cost 11,468 (4,591) * Mean ± standard deviation. Demographics and perioperative patients’ data are presented in Table 1. Approximately 70% of the study sample was comprised of male patients, with a mean age of 52.8 years (SD: 14.6). The most common comorbidities were hypertension (18%) and IHD (12%). In one year, the success rate was 83.6%. In the evaluation of possible predictors of longer event-free rate, none of the comorbidities investigated (hypertension, heart failure, and ischemic or valvular heart disease) was associated with this outcome (p > 0.05 for all variables in the log-rank test). Only one patient suffered peri-procedural complications (a hemorrhagic stroke). Table 2 presents monthly resource use and costs before and after the ablation procedure. The monthly median number of emergency department visits reduced from 0.10 (IQR: 0.04 – 0.23) in the pre-ablation period to 0 (IQR: 0 – 0.11) in the post-ablation period (p < 0.001). Median monthly total costs had a 68.5% decrease, from 330.95 (IQR: 142.36 – 754.17) to 104.21 (IQR: 56. 35 – 226,51, p < 0.001). Outpatient and emergency-related costs were also reduced, by 48.8% and 100%, respectively (p < 0.001 for both variables). The monthly number of elective hospital admissions and its related costs, as well as outpatient office visits, did not have a statistically significant change between pre- and post‑ablation periods. In the analysis of variables associated with a greater reduction in total monthly cost after the ablation procedure, none of the comorbidities evaluated – hypertension, heart failure, and ischemic or valvular heart disease – showed statistical significance (p > 0.10 for all variables). Discussion In this study, we found that catheter ablation resulted in reduced ambulatory and hospital care costs during a mean post-procedural follow-up of 10.7 months, with a monthly median cost reduction of 68.5%: from BRL 330.95 before to BRL 104.21 after the procedure. Cost reduction occurred both in the outpatient setting (from BRL 121.48 to BRL 62.70) and in the emergency-related component (from BRL 65.21 to BRL 0). The procedure presented a success rate of 83.6% after 1 year of follow up which is compatible with recent studies conducted elsewhere using contact-force catheters. 13,14 The number of serious complications was 1.2%, which is not different from other small cohorts in the literature. 16,17 254