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Sex, Race, and Rural-Urban Disparities in VT Ablations
Quick Takes
- Significant disparities exist among patients with VT undergoing ablation in the inpatient setting, even after adjusting for baseline demographics and comorbidities.
- VT ablation may be underutilized in historically marginalized patient populations and a large urban-rural divide in access to care may exist.
- Additional studies are indicated to better understand mechanisms underlying disparities in VT ablation and to assess interventions likely to be effective in mitigating these disparities.
Study Questions:
Are there differences in patients hospitalized with ventricular tachycardia (VT) who received catheter ablations with potential disparities in access and utilization of VT ablation?
Methods:
The investigators used the National Inpatient Sample to assess patients hospitalized with a primary diagnosis of VT in 2019 who did and did not receive catheter ablations. Multiple logistic regression was used to calculate risk factors for VT ablation based on age, sex, race/ethnicity, socioeconomic status, and hospital characteristics.
Results:
After adjusting for baseline characteristics and comorbidities, female and Black patients hospitalized with VT had significantly lower odds of receiving ablations compared to male and White patients (odds ratio [OR], 0.835; 95% confidence interval [CI], 0.699-0.997; p = 0.047 and OR, 0.617; 95% CI, 0.457-0.832; p = 0.002), respectively. Additionally, patients at rural or nonteaching hospitals were significantly less likely to receive ablations compared to those at urban teaching hospitals. No significant differences were noted based on income or insurance status in the adjusted models.
Conclusions:
The authors report significant disparities in the delivery of ventricular ablations among patients hospitalized with VT.
Perspective:
This study reports significant disparities among patients with VT undergoing ablation in the inpatient setting, even after adjusting for baseline demographics and comorbidities. Of note, female patients were roughly 15% less likely to receive ablations compared to males and Black patients were nearly 40% less likely to receive ablations compared to White patients. Furthermore, patients admitted to rural and nonteaching hospitals were 60-85% less likely to undergo ablation compared to those at urban teaching hospitals. These findings suggest that VT ablation may be underutilized in historically marginalized patient populations and that a large urban-rural divide in access to care may exist. Additional studies are indicated to better understand mechanisms underlying disparities in VT ablation and to assess interventions likely to be effective in mitigating these disparities.
Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Catheter Ablation, Healthcare Disparities, Tachycardia, Ventricular
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