title: Overcoming reporting challenges: How to display, summarize, and model late reintervention outcomes, follow-up, and vital status information after surgery for atrial fibrillation.
abstract: BACKGROUND
  Postsurgical late reinterventions for atrial fibrillation (AF) include cardioversions (CV) or catheter ablations (CA). Commonly used methods for reporting and modeling the frequency and timing of CA or CV have well-known shortcomings.
  
  
  OBJECTIVE
  The purpose of this study was to present intuitive and robust methods to visualize, summarize, and model late reinterventions type/timing and vital status simultaneously.
  
  
  METHODS
  We present (1) the SMART plot (Summary of Mortality And Outcomes Reported Over Time); (2) the reintervention mean cumulative function (MCF); and (3) the proportional means model and the proportional rates model. We illustrate these methods in 3 groups: patients age ≤60 years, 60-75 years (reference), and >75 years who underwent surgical AF ablation.
  
  
  RESULTS
  Patients age >75 years had a significantly lower MCF of CVs (hazard ratio [HR] 0.50, P <.001). MCF for CAs was not significantly lower for patients age >75 years (HR 0.57, P = .13). For combined reinterventions (CV or CA), the age group >75 years had a significantly lower MCF (HR 0.51, P <.001). There were no significant differences in late CV or CA reintervention patterns for patients age ≤60 years.
  
  
  CONCLUSIONS
  The methods presented provide a comprehensive framework for displaying, summarizing, and modeling repeated late reinterventions after surgical AF ablation. Other areas of application are described, further emphasizing the potential for immediate use.
authors.affiliation: Bluhm Cardiovascular Institute-Northwestern Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Electronic address: aandrei@nm.org.
authors.forename: Adin-Cristian
authors.initials: AC
authors.lastname: Andrei
authors.affiliation: Bluhm Cardiovascular Institute-Northwestern Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
authors.affiliation: Bluhm Cardiovascular Institute-Northwestern Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.affiliation: Bluhm Cardiovascular Institute-Northwestern Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Travis O
authors.initials: TO
authors.lastname: Abicht
authors.affiliation: Bluhm Cardiovascular Institute-Northwestern Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: S Chris
authors.initials: SC
authors.lastname: Malaisrie
authors.affiliation: Bluhm Cardiovascular Institute-Northwestern Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Li
authors.affiliation: Bluhm Cardiovascular Institute-Northwestern Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Jane
authors.initials: J
authors.lastname: Kruse
authors.affiliation: Division of Cardiovascular Medicine, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Albert L
authors.initials: AL
authors.lastname: Waldo
authors.affiliation: Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.affiliation: Division of Cardiothoracic Surgery Emeritus, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: James L
authors.initials: JL
authors.lastname: Cox
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D004554:Electric Countershock / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D019233:Retreatment / Q000379:methods / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Atrial fibrillation; Cardioversion; Catheter ablation; Late reintervention; Recurrent event; Surgical ablation