By: James Pitt  Oct. 08, 2018
Atrial fibrillation, the most common arrhythmia, is a condition in which the heart's upper chambers contract rapidly and irregularly. Twenty years ago, Haïssaguerre et. al discovered that pulmonary veins can spontaneously trigger AFib, and isolating pulmonary veins from each other with radiofrequency catheter ablation can correct it.
Catheter ablation reduced death (hazard ratio 0.53) and heart failure rehospitalization (hazard ratio 0.56) compared to rate or rhythm control therapy, according to a randomized trial published in the February 2018 New England Journal of Medicine.
The National Heart, Lung, and Blood Institute recognizes three subtypes of AFib. Subtypes are based on how long episodes of abnormal heart rhythm last. In paroxysmal AFib, the abnormal rhythm stops in under a week; in persistent AFib, the rhythm lasts a week or longer; and in permanent AFib, the rhythm lasts until treated.
Dexur analysts used ICD-10 diagnosis and procedure codes to examine treatment practices in paroxysmal AFib. The most common DRG codes assigned to paroxysmal Afib treatment are DRG 273 (percutaneous intracardiac procedures with major complications/ comorbidities) and DRG 274 (without major complications/ comorbidities).
Paroxysmal atrial fibrillation hospitalizations have an average length of stay 0.83 days shorter when treated with percutaneous intracardiac procedures (without major complications/ comorbidities) than overall. Nationally, this results in an average savings of $1,725 per paroxysmal atrial fibrillation hospitalization, or nearly $121 million overall.
As a case study, Dexur analysts examined the potential value at three Arkansas hospitals. Analysts determined the amount of money each hospital would save If all that hospital's AFib hospitalizations had the same length of stay as that hospital's AFib hospitalizations with percutaneous intracardiac procedure without MCC.
Washington Regional Medical Center (Fayettesville, AR) would save $2,724,259 per year. St. Bernard's Medical Center (Jonesboro, AR) would save $16,434,596 per year. St. Vincent Infirmary Medical Center (Little Rock, AR) would save $10,129,497 per year.
Washington Regional Medical Center, which has three of the top ten cardiac arrhythmia doctors in Arkansas, has about four times as many patients with percutaneous intracardiac procedures without MCC as the other two hospitals. Percutaneous intracardiac devices for paroxysmal AFib ablation, such as the Cardiofocus Heartlight, may provide these hospitals value for AFib patients.
1-year value analyses of DRG 274 for patients with atrial fibrillation as primary hospitalization reason for: