OBJECTIVES: We assessed the healthcare resource utilization (HCRU) and costs after patients with atrial fibrillation (AF) underwent cardiac catheter ablation surgery and examined disparities in rural healthcare settings.

METHODS: This was a pre-post comparison study. Data were collected from IBM MarketScan Research Databases 2015-2019. We identified AF patients who underwent ablation after AF diagnosis. We calculated the HCRU and costs in the post period between the second and the 12^th months following ablation, and in the pre-period between the 12 months and 1 month prior to ablation, to reduce the impact of surgery on outcomes. Rural status was identified by Metropolitan Statistical Area. We compared the HCRU and costs for payers and patients in the post period to the pre period by paired t-test stratified by payer. We used linear regression to assess the association between rural setting and change in HCRU or costs.

RESULTS: We identified 9,614 AF patients who underwent ablation. Compared to the pre-period, patients used fewer services in the post-period for emergency room visits (Medicare -0.29, 95%CI: -0.37; Commercial -0.52, 95%CI: -0.56, -0.48) and inpatient admission (Medicare -0.17, 95%CI: -0.21, -0.13; Commercial -0.24, 95%CI: -0.26, -0.22) but more outpatient visits (Medicare 6.28, 95%CI: 5.48, 7.10; Commercial 2.50, 95%CI: 2.14, 2,85). Excluding surgery costs, patients had higher costs for payers after ablation ($2,148, 95%CI: 1,223, 3,074 for Medicare, $1,176, 95%CI: 41, 2,312 for commercial plans). Rural dwelling patients were not associated with additional HCRU compared to urban dwelling patients, except lower emergency room visits (-0.1, 95%CI: -0.19, -0.02) or associated with differences in costs for payers ($1,463, 95%CI: -863, 3,790) or costs for patients ($1,454, 95%CI: -905, 3,813).