Author + information
- Received June 27, 2016
- Revision received August 9, 2016
- Accepted September 1, 2016
- Published online March 20, 2017.
- Sheldon M. Singh, MDa,∗ (, )
- Lauren Webster, MPHb,
- Dennis T. Ko, MD, MSca,b,c,
- Jack V. Tu, MD, PhDa,b,c and
- Harindra C. Wijeysundera, MD, PhDa,b,c
- aSchulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- bInstitute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- cInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ↵∗Address for correspondence:
Dr. Sheldon M. Singh, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Objectives This study sought to determine factors associated with cardiac electrophysiologist assessment and atrial fibrillation (AF) ablation in patients with new-onset AF.
Background Factors driving variation in the use of AF ablation have not been well described.
Methods All individuals with new-onset AF in Ontario, Canada, between January 1, 2010, and December 31, 2012, were identified. Survival analysis accounting for the competing risk of death was used to evaluate the association between clinical and nonclinical factors and receipt of an electrophysiologist assessment. Factors associated with AF ablation were then determined in the subgroup of patients who received an electrophysiologist assessment.
Results A total of 22,032 patients with new-onset AF were identified, 8,161 (37%) of whom received an electrophysiology assessment. Prior cardiologist care was associated with electrophysiologist assessment (hazard ratio [HR]: 1.57; p < 0.0001). Rural residence was associated with a decreased incidence of electrophysiology assessment (HR: 0.80; p < 0.0001). A total of 424 (5.2%) patients receiving an electrophysiologist assessment had an AF ablation. Recurrent AF emergency department (ED) visits between the index ED visit and the initial electrophysiologist assessment (HR for ≥2 ED visits: 4.22; p < 0.0001) and rural residence (HR: 1.50; p = 0.002) were both associated with AF ablation. Cardiovascular comorbidities were associated with a decreased incidence of AF ablation.
Conclusions Rural patients with AF have a lower incidence of electrophysiologist assessment but paradoxically a higher incidence of AF ablation compared with their urban counterparts. Clinical factors such as recurrent ED visits for AF and cardiovascular comorbidities are the most important factors associated with of AF ablation.
This study was supported by a Heart & Stroke Foundation/University of Toronto Polo Chair in Cardiology Young Investigator Award and a generous donation from the Tambakis family. Additional support was obtained from the Institute for ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Dr. Ko is supported by a Mid-Career Scientist Award from the Heart and Stroke Foundation of Canada, Ontario Office. Dr. Tu is supported by a Tier 1 Canada Research Chair in Health Services Research and an Eaton Scholar Award. Dr. Wijeysundera is supported by a Distinguished Clinical Scientist Award from the Heart and Stroke Foundation of Canada. The funding organizations did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by Canadian Institutes for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of CIHI. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors' institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 27, 2016.
- Revision received August 9, 2016.
- Accepted September 1, 2016.
- 2017 American College of Cardiology Foundation