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Racial/Ethnic and Socioeconomic Disparities in Paroxysmal AF
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- Black race and lower zip code–linked median household income were independently associated with lower use of rhythm control.
- Latinx ethnicity and lower zip code–linked median household income were independently associated with lower catheter ablation use among those receiving rhythm control.
Study Questions:
What are the rates of antiarrhythmic drug and catheter ablation use for the management of paroxysmal atrial fibrillation (AF), and what is the association of their use with race/ethnicity and socioeconomic status in the United States?
Methods:
This cohort study obtained inpatient, outpatient, and pharmacy claims data from the Optum Clinformatics Data Mart over a 4-year period for patients with a diagnosis of incident paroxysmal AF.
Results:
A total of 109,221 patients met the inclusion criteria; 51% were men and 67% were White. 79% of patients were treated with rate control, 17.7% with antiarrhythmic drugs, and 3.2% with catheter ablation. Between 2016 and 2019, the percentage of patients treated with catheter ablation increased from 1.6% to 3.8%. In multivariable analyses, Black race and lower zip code–linked median household income were independently associated with lower use of rhythm control. Latinx ethnicity and lower zip code–linked median household income were independently associated with lower catheter ablation use among those receiving rhythm control. Patients with a zip code–linked median household income of <$50,000 were 17% less likely to receive a rhythm control strategy and 39% less likely to receive catheter ablation compared with those with a median household income of ≥$100,000.
Conclusions:
The authors concluded that patients from racial/ethnic minority groups and those with lower income were less likely to receive rhythm control treatment, especially catheter ablation, in the management of incident AF.
Perspective:
A great many prior studies have shown inequities in health care in the United States across gender, race/ethnicity, socioeconomic status, and other minority characteristics. The present study looks specifically at antiarrhythmic drug and ablation therapy use as opposed to rate control strategy across race/ethnicity and socioeconomic status. Importantly, 100% of patients in this study had commercial insurance and the results were adjusted for the number of outpatient cardiology visits in order to minimize confounding stemming from poorer access to specialists. Black race and lower zip code–linked median household income were independently associated with lower use of rhythm control strategy. Latin ethnicity and lower zip code–linked median household income were independently associated with lower catheter ablation use among those receiving rhythm control. The factors that lead to this inequity should be further studied. They may include patient advocacy (White patients advocating for rhythm control for themselves), lower rates of confidence to engage in health care decisions among minority populations, or affordability of copays for antiarrhythmic drugs and catheter ablation, etc.... Addressing structural racism and the barriers to accessing cardiology care for marginalized patient groups is indeed needed. It is also notable that the rate of catheter ablation was only 3.2% for the overall population, demonstrating that there may be poor adoption of advanced ablation procedures.
Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Costs and Cost Analysis, Delivery of Health Care, Ethnic Groups, Healthcare Disparities, Income, Inpatients, Minority Groups, Outpatients, Secondary Prevention, Social Class, Socioeconomic Factors
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