Racial Disparity in Referral for Catheter Ablation for Atrial Fibrillation at a Single Integrated Health System

J Am Heart Assoc. 2022 Sep 20;11(18):e025831. doi: 10.1161/JAHA.122.025831. Epub 2022 Sep 8.

Abstract

Background Guidelines recommend catheter ablation of atrial fibrillation (AFCA) as an option for rhythm control. Studies have shown that Black patients are less likely to undergo AFCA compared with White patients. We investigated whether differences in referral patterns play a role in this observed disparity. Methods and Results Using an integrated repository from the electronic medical record at Northwestern Medicine, we conducted a retrospective cohort study of outpatients with newly diagnosed atrial fibrillation. Baseline characteristics by race and ethnicity were compared. Logistic regression models adjusted for socioeconomic and health factors were constructed to determine the association between race and ethnicity and binary dependent variables including referrals and visits to general cardiology and cardiac electrophysiology (EP) and AFCA. Of 5445 patients analyzed, 4652 were non-Hispanic White (NHW) and 793 were non-Hispanic Black (NHB). In adjusted models, NHB patients initially diagnosed with atrial fibrillation in internal medicine and primary care had a significantly greater odds of referral to general cardiology; among all patients in the cohort, there was no significant difference in the odds of referral to EP between NHB and NHW patients; and there were no differences in the odds of completing a visit in general cardiology or EP. Among patients completing an EP visit, NHB patients were less likely to undergo AFCA (odds ratio, 0.63 [95% CI, 0.40-0.98], P=0.040). Conclusions Similar referral rates to general cardiology and EP were observed between NHB and NHW patients. Despite this, NHB patients were less likely to undergo AFCA.

Keywords: atrial fibrillation; catheter ablation; health care disparities.

MeSH terms

  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / surgery
  • Black or African American
  • Catheter Ablation* / adverse effects
  • Delivery of Health Care, Integrated*
  • Humans
  • Referral and Consultation
  • Retrospective Studies
  • White People