Gender, Ethnic, and Socioeconomic Differences in Access to Catheter Ablation Therapy in Patients with Atrial Fibrillation

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2023 Jan 23

PMID 36684570

Authors

Hani Hamade

Ahmad Jabri

Pooja Mishra

Muhammad Umer Butt

Sherin Sallam

Saima Karim

Affiliations

Soon will be listed here.

Abstract

Introduction: Female patients, patients from racial minorities, and patient with low socioeconomic status have been noted to have less access to catheter ablation for atrial fibrillation.

Methods: This is a cross-sectional, retrospective study using a large population database (Explorys) to evaluate the gender, racial and socioeconomic differences in access of catheter ablation therapy in patient with atrial fibrillation.

Results: A total of 2.2 million patients were identified as having atrial fibrillation and 62,760 underwent ablation. Females had ablation in 2.1% of cases while males received ablation in 3.4% of cases. Caucasians had ablation in 3.3% of cases, African Americans in 1.5% of cases and other minorities in 1.2% of cases. Individuals on medicaid underwent ablation in 1.6% of cases, individuals on medicare and private insurance had higher rates (2.8 and 2.9%, respectively). Logistic regression showed that female patients (OR 0.608, CI 0.597-0.618, < 0.0001), patients who are African American (OR 0.483, CI 0.465-0.502, < 0.0001), or from other racial minorities (OR 0.343, CI 0.332-0.355, < 0.0001) were less likely to undergo ablation. Patient with medicare (OR 1.444, CI 1.37-1.522, < 0.0001) and private insurance (OR 1.572, CI 1.491-1.658, < 0.0001) were more likely to undergo ablation.

Conclusion: Female gender, racial minorities, low socioeconomic status are all associated with lower rates of catheter ablation in management of atrial fibrillation.

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References

Lee J, Kim T, Cha M, Park J, Park J, Kang K . Gender-related Differences in Management of Nonvalvular Atrial Fibrillation in an Asian Population. Korean Circ J. 2018; 48(6):519-528. PMC: 5986752. DOI: 10.4070/kcj.2017.0389. View

Golwala H, Jackson 2nd L, Simon D, Piccini J, Gersh B, Go A . Racial/ethnic differences in atrial fibrillation symptoms, treatment patterns, and outcomes: Insights from Outcomes Registry for Better Informed Treatment for Atrial Fibrillation Registry. Am Heart J. 2016; 174:29-36. DOI: 10.1016/j.ahj.2015.10.028. View

Durrani A, Soma S, Althouse A, Leef G, Qin D, Saba S . Impact of Race on Outcome of Patients Undergoing Rhythm Control of Atrial Fibrillation. J Immigr Minor Health. 2017; 20(1):14-19. DOI: 10.1007/s10903-016-0545-5. View

Andrade J, Deyell M, Lee A, Macle L . Sex Differences in Atrial Fibrillation. Can J Cardiol. 2018; 34(4):429-436. DOI: 10.1016/j.cjca.2017.11.022. View

Essien U, Holmes D, Jackson 2nd L, Fonarow G, Mahaffey K, Reiffel J . Association of Race/Ethnicity With Oral Anticoagulant Use in Patients With Atrial Fibrillation: Findings From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II. JAMA Cardiol. 2018; 3(12):1174-1182. PMC: 6583087. DOI: 10.1001/jamacardio.2018.3945. View

Takigawa M, Kuwahara T, Takahashi A, Watari Y, Okubo K, Takahashi Y . Differences in catheter ablation of paroxysmal atrial fibrillation between males and females. Int J Cardiol. 2013; 168(3):1984-91. DOI: 10.1016/j.ijcard.2012.12.101. View

Olsen F, Uleberg B, Jacobsen B, Heuch I, Tande P, Bugge E . Socioeconomic and geographic differences in ablation of atrial fibrillation in Norway - a national cohort study. BMC Public Health. 2022; 22(1):303. PMC: 8842863. DOI: 10.1186/s12889-022-12628-9. View

Vogel B, Acevedo M, Appelman Y, Merz C, Chieffo A, Figtree G . The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet. 2021; 397(10292):2385-2438. DOI: 10.1016/S0140-6736(21)00684-X. View

Bhave P, Lu X, Girotra S, Kamel H, Vaughan Sarrazin M . Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation. Heart Rhythm. 2015; 12(7):1406-12. PMC: 4787261. DOI: 10.1016/j.hrthm.2015.03.031. View

10.

Casey J, Pollak J, Glymour M, Mayeda E, Hirsch A, Schwartz B . Measures of SES for Electronic Health Record-based Research. Am J Prev Med. 2017; 54(3):430-439. PMC: 5818301. DOI: 10.1016/j.amepre.2017.10.004. View

11.

Russo A . Catheter Ablation Is Better Than Drugs for Treatment of AF in Racial and Ethnic Minorities. J Am Coll Cardiol. 2021; 78(2):139-141. DOI: 10.1016/j.jacc.2021.05.008. View

12.

Thomas K, Al-Khalidi H, Silverstein A, Monahan K, Bahnson T, Poole J . Ablation Versus Drug Therapy for Atrial Fibrillation in Racial and Ethnic Minorities. J Am Coll Cardiol. 2021; 78(2):126-138. PMC: 8354144. DOI: 10.1016/j.jacc.2021.04.092. View

13.

Gu K, Mahtta D, Kaneria A, Sharedalal P, Dennis B, Song Y . Racial disparities among Asian Americans with atrial fibrillation: An analysis from the NCDR® PINNACLE Registry. Int J Cardiol. 2021; 329:209-216. DOI: 10.1016/j.ijcard.2020.12.064. View

14.

Grubitzsch H, Grabow C, Orawa H, Konertz W . Factors predicting the time until atrial fibrillation recurrence after concomitant left atrial ablation. Eur J Cardiothorac Surg. 2008; 34(1):67-72. DOI: 10.1016/j.ejcts.2008.03.054. View

15.

Kaiser D, Fan J, Schmitt S, Than C, Ullal A, Piccini J . Gender Differences in Clinical Outcomes after Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol. 2018; 2(6):703-710. PMC: 5881580. DOI: 10.1016/j.jacep.2016.04.014. View

16.

Westerman S, Wenger N . Gender Differences in Atrial Fibrillation: A Review of Epidemiology, Management, and Outcomes. Curr Cardiol Rev. 2018; 15(2):136-144. PMC: 6520576. DOI: 10.2174/1573403X15666181205110624. View

17.

Patel N, Deshmukh A, Thakkar B, Coffey J, Agnihotri K, Patel A . Gender, Race, and Health Insurance Status in Patients Undergoing Catheter Ablation for Atrial Fibrillation. Am J Cardiol. 2016; 117(7):1117-26. DOI: 10.1016/j.amjcard.2016.01.040. View

18.

Patel D, Mohanty P, Di Biase L, Sanchez J, Shaheen M, Burkhardt J . Outcomes and complications of catheter ablation for atrial fibrillation in females. Heart Rhythm. 2009; 7(2):167-72. DOI: 10.1016/j.hrthm.2009.10.025. View

19.

Ngo L, Ali A, Ganesan A, Woodman R, Adams R, Ranasinghe I . Gender differences in complications following catheter ablation of atrial fibrillation. Eur Heart J Qual Care Clin Outcomes. 2021; 7(5):458-467. DOI: 10.1093/ehjqcco/qcab035. View

20.

Ugowe F, Jackson 2nd L, Thomas K . Racial and ethnic differences in the prevalence, management, and outcomes in patients with atrial fibrillation: A systematic review. Heart Rhythm. 2018; 15(9):1337-1345. DOI: 10.1016/j.hrthm.2018.05.019. View