title: Geographic variation in the use of catheter ablation for atrial fibrillation among Medicare beneficiaries.
abstract: BACKGROUND
  Catheter ablation for atrial fibrillation is used increasingly in older patients, yet the risks and benefits are not completely understood. With such uncertainty, local medical opinion may influence catheter ablation use.
  
  
  METHODS
  In a 100% sample of Medicare beneficiaries ≥65 years who underwent catheter ablation for atrial fibrillation between January 1, 2007, and December 31, 2009, we investigated variation in use by hospital referral region (HRR) for 20,176 catheter ablation procedures.
  
  
  RESULTS
  Across 274 HRRs, median age was 71.2 years (interquartile range 70.5-71.8), a median of 98% of patients were white, and a median of 39% of patients were women. The median age-standardized prevalence of atrial fibrillation was 77.1 (69.4-84.2) per 1,000 beneficiaries; the median rate of catheter ablation was 3.5 (2.4-4.9) per 1,000 beneficiaries. We found no significant associations between the rate of catheter ablation and prevalence of atrial fibrillation (P = .99), end-of-life Medicare expenditures per capita (P = .09), or concentration of cardiologists (P = .45) but a slight association with Medicare expenditures per capita (linear regression estimate 0.016; 95% CI 0.001-0.031; P = .04). Examined HRR characteristics explained only 2% of the variation in HRR-level rates of catheter ablation (model R(2) = 0.016).
  
  
  CONCLUSIONS
  The rate of catheter ablation for atrial fibrillation in older patients was low, varied substantially by region, and was not associated with the prevalence of atrial fibrillation, the availability of cardiologists, or end-of-life resource use and was only slightly associated with overall Medicare expenditures per capita.
authors.affiliation: Department of Medicine I, University Hospital Munich, Campus Grosshadern, Ludwig Maximilians University, Munich, Germany.
authors.forename: Moritz F
authors.initials: MF
authors.lastname: Sinner
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.|Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Greiner
authors.affiliation: Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Walkey
authors.affiliation: Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Wallace
authors.affiliation: Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.|Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.|Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000601:surgery*; D002309:Cardiology; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D015995:Prevalence; D018570:Risk Assessment; D013727:Terminal Care / Q000191:economics; D014481:United States / Q000453:epidemiology; D000078329:Workforce