Racial/ethnic and sex differences in safety outcomes and atrial fibrillation/atrial flutter-related acute healthcare utilization after catheter ablation of atrial fibrillation

Larry R Jackson 2nd; Daniel J Friedman; Diane M Francis; Sonia Maccioni; Vincent C Thomas; Jennifer Wood; Rahul Khanna; Charlene Wong; Neloufar Rahai; Jonathan P Piccini

doi:10.1016/j.hroo.2023.02.005

Racial/ethnic and sex differences in safety outcomes and atrial fibrillation/atrial flutter-related acute healthcare utilization after catheter ablation of atrial fibrillation

Heart Rhythm O2. 2023 Feb 16;4(5):291-297. doi: 10.1016/j.hroo.2023.02.005. eCollection 2023 May.

Authors

Affiliations

¹ Department of Internal Medicine, Adult Cardiac Electrophysiology Section, Duke University Medical Center, Durham, North Carolina.
² Health Economics and Market Access, Johnson & Johnson Medical Devices, Irvine, California.
³ Biosense Webster, Irvine, California.
⁴ Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey.

Abstract

Background: Catheter ablation is recommended for the treatment of symptomatic atrial fibrillation (AF) refractory to medical therapy.

Objective: The study sought to examine racial/ethnic and sex differences in complications and AF/atrial flutter (AFL)-related acute healthcare utilization following catheter ablation for AF.

Methods: We performed a retrospective analysis using data from the Centers for Medicare and Medicaid Services Medicare Standard Analytical Files (October 1, 2014, to September 30, 2019) among patients ≥65 years of age with AF who underwent catheter ablation for rhythm control. The risk of any complication within 30 days and AF/AFL-related acute healthcare utilization within 1 year of ablation by race, ethnicity, and sex were assessed using multivariable Cox regression modeling.

Results: We identified 95,394 patients for analysis of postablation complications and 68,408 patients for analysis of AF/AFL-related acute healthcare utilization. Both cohorts were ∼95% White and 52% male. Female patients had a slightly elevated risk of complications compared with male patients (adjusted hazard ratio [aHR] 1.07, 95% confidence interval [CI] 1.03-1.12). Black (aHR 0.78, 95% CI 0.77-1.00) and Asian (aHR 0.67, 95% CI 0.50-0.89) patients had lower utilization compared with White patients. Specifically, Asian men (aHR 0.58, 95% CI 0.38-0.91) had lower utilization compared with White men.

Conclusion: Differences in safety and healthcare utilization after catheter ablation for AF were observed by race/ethnicity and sex groups. Underrepresented racial and ethnic groups with AF had a lower risk of AF/AFL-related acute healthcare utilization postablation.

Keywords: Atrial fibrillation; Catheter ablation; Complications; Ethnicity; Race; Safety.