Readmissions common, costly after ablation of MI-associated VT

Almost 1 in 5 patients are rehospitalized within 30 days of undergoing catheter ablation of MI-associated ventricular tachycardia (VT), according to a study from the Nationwide Readmissions Database. These patients rack up 38.9 percent higher cumulative hospital costs than those who aren’t readmitted, researchers reported in Circulation: Arrhythmia and Electrophysiology.

“Catheter ablation has emerged as the main treatment for patients with drug-refractory scar-associated ventricular tachycardia, particularly those with prior myocardial infarction (MI),” wrote lead author Jim W. Cheung, MD, with Weill Cornell Medical College in New York, and colleagues. “However, patients with MI-associated VT often have comorbidities such as congestive heart failure (CHF) and pulmonary disease that may be associated with significantly increased risk of complications and mortality after ablation.”

Despite these observations, Cheung et al. said there have been few studies into readmissions after VT ablation, and the relatively limited outcomes data are based on research from specialized centers, which may not accurately reflect typical complication and mortality rates.

The authors used the Nationwide Readmissions Database to evaluate 4,109 admissions for ablation of MI-associated VT between 2010 and 2015, along with the frequency and predictors of in-hospital mortality, complications and 30-day readmissions. Transfers to other hospitals weren’t counted as readmissions, and only the first readmission for each patient within 30 days of discharge was included in the analysis.

The rates of in-hospital mortality and complications following VT ablation were 2.7 percent and 11.5 percent, respectively. Among the 4,000 patients who survived to hospital discharge, 19.2 percent were readmitted within 30 days, and the mortality rate during those readmissions was 2.9 percent.

“We identified a high 30-day readmission rate after VT ablation of 19.2%, which remained stable between 2010 and 2015,” the authors wrote. “The absence of a reduction in readmission rates may be due in part to the absence of substantial improvements in complication rates and procedural success rates during this time period. It may also be because of an upward trend in the comorbidity burden among patients undergoing VT ablation.”

Pulmonary hypertension was linked to a 2.7-fold increased risk of 30-day readmission, and the next strongest predictor was an index hospitalization of a week or longer, which was tied a 1.67-fold risk of readmission. Congestive heart failure, smaller hospital size, smoking and chronic pulmonary disease were also associated with a higher risk of readmission.

Other potential explanations for the high readmission rate, the authors said, include the commonality of recurrent VT within 30 days of an ablation and the complexity of VT ablations, which could be associated with procedural complications that increase the odds of longer hospitalizations or readmissions.

The median cost of an index hospitalization for the study population was $28,646, whereas the median cumulative cost of the initial hospitalization plus one readmission was $43,776. Recurrent VT and congestive heart failure accounted for 41 percent and 14 percent of all readmissions, respectively.

“Strategies to reduce recurrent VT postablation by improving procedural success, optimizing postablation heart failure treatment, and ensuring close postdischarge follow-up may help reduce readmissions and healthcare costs,” Cheung and coauthors wrote. “A multipronged approach that addresses the leading cardiac and noncardiac causes of readmission would help reduce costs and would further tilt the cost-effectiveness of VT ablation over that of drug escalation.”

Patients who underwent VT ablation in one state but were readmitted in another wouldn’t be captured by the database, leading to the possibility that readmission rates were underestimated. In addition, mortality data wasn’t captured for deaths occurring in the emergency room or outside of the hospital, the researchers noted.