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Jackson LR, Friedman DJ, Francis DM, Maccioni S, Thomas VC, Wood J, Khanna R, Wong C, Rahai N, Piccini JP. 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; 4:291-297. [PMID: 37323995 PMCID: PMC10264254 DOI: 10.1016/j.hroo.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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.
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Affiliation(s)
- Larry R. Jackson
- Department of Internal Medicine, Adult Cardiac Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
| | - Daniel J. Friedman
- Department of Internal Medicine, Adult Cardiac Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
| | - Diane M. Francis
- Health Economics and Market Access, Johnson & Johnson Medical Devices, Irvine, California
| | - Sonia Maccioni
- Health Economics and Market Access, Johnson & Johnson Medical Devices, Irvine, California
| | | | - Jennifer Wood
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey
| | - Rahul Khanna
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey
| | - Charlene Wong
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey
| | - Neloufar Rahai
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey
| | - Jonathan P. Piccini
- Department of Internal Medicine, Adult Cardiac Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
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Hamade H, Jabri A, Mishra P, Butt MU, Sallam S, Karim S. Gender, ethnic, and socioeconomic differences in access to catheter ablation therapy in patients with atrial fibrillation. Front Cardiovasc Med 2023; 9:966383. [PMID: 36684570 PMCID: PMC9846247 DOI: 10.3389/fcvm.2022.966383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023] Open
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, p < 0.0001), patients who are African American (OR 0.483, CI 0.465-0.502, p < 0.0001), or from other racial minorities (OR 0.343, CI 0.332-0.355, p < 0.0001) were less likely to undergo ablation. Patient with medicare (OR 1.444, CI 1.37-1.522, p < 0.0001) and private insurance (OR 1.572, CI 1.491-1.658, p < 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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Affiliation(s)
- Hani Hamade
- Department of Internal Medicine, The Metrohealth System, Cleveland, OH, United States
| | - Ahmad Jabri
- Heart and Vascular Center, The Metrohealth System, Cleveland, OH, United States
| | - Pooja Mishra
- Advocate Heart Institute, Advocate Healthcare, Chicago, IL, United States
| | - Muhammad Umer Butt
- Department of Cardiology, New York University Langone Health, New York, NY, United States
| | - Sherin Sallam
- Department of Internal Medicine, University Hospitals, Cleveland, OH, United States
| | - Saima Karim
- Heart and Vascular Center, The Metrohealth System, Cleveland, OH, United States,*Correspondence: Saima Karim ✉
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Thomas KL, Garg J, Velagapudi P, Gopinathannair R, Chung MK, Kusumoto F, Ajijola O, Jackson LR, Turagam MK, Joglar JA, Sogade FO, Fontaine JM, Krahn AD, Russo AM, Albert C, Lakkireddy DR. Racial and ethnic disparities in arrhythmia care: A call for action. Heart Rhythm 2022; 19:1577-1593. [PMID: 35842408 PMCID: PMC10124949 DOI: 10.1016/j.hrthm.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Kevin L Thomas
- Division of Cardiac Electrophysiology, Duke University School of Medicine, Durham, North Carolina
| | - Jalaj Garg
- Cardiac Arrhythmia Service, Loma Linda University Hospital, Loma Linda, California
| | - Poonam Velagapudi
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Mina K Chung
- Cardiac Pacing and Electrophysiology, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fred Kusumoto
- Heart Rhythm Services, Mayo Clinic, Jacksonville, Florida
| | - Olujimi Ajijola
- Ronald Reagan University of California Los Angeles Cardiac Arrhythmia Center, Los Angeles, California
| | - Larry R Jackson
- Division of Cardiac Electrophysiology, Duke University School of Medicine, Durham, North Carolina
| | - Mohit K Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jose A Joglar
- Division of Cardiology, Clinical Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Felix O Sogade
- Clinical Cardiac Electrophysiology, Georgia Arrhythmia Consultants, Macon, Georgia
| | - John M Fontaine
- Clinical Cardiac Electrophysiology Service, University of Pittsburgh Medical Center Williamsport, Williamsport, Pennsylvania
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Division of Cardiovascular Disease, Cooper University Hospital, Camden, New Jersey
| | - Christine Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Alhuneafat L, Jabri A, Poornima IG, Alrifai N, Ali M, Elhamdani A, Kyvernitakis A, Al-Abdouh A, Mhanna M, Hadaddin F, Butt M, Cunningham C, Karim S, Ziv O. Ethnic and Racial Disparities in Resource Utilization and In-hospital Outcomes Among Those Admitted for Atrial Fibrillation: A National Analysis. Curr Probl Cardiol 2022; 47:101365. [PMID: 36031016 DOI: 10.1016/j.cpcardiol.2022.101365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Disparities in overall outcomes for atrial fibrillation (AF) across racial and ethnic groups have been demonstrated in prior studies. We aim to evaluate in-hospital outcomes and resource utilization across three racial/ethnic groups with AF using contemporary data. METHODS We identified patients admitted with AF in the National Inpatient Sample registry from 2015 to 2018. ICD-10-CM codes were used to identify variables of interest. The primary outcomes were in-hospital complications and resource utilization. RESULTS There were 1,250,075 AF admissions. Our sample was made up of 85.49% White, 8.12% Black, and 6.38% Hispanic patients. Black patients were younger but had a higher burden of cardiovascular comorbidities including obesity, hypertension, and chronic kidney disease. Social determinants were also less favorable in Black patients, with a higher percentage of Medicaid insurance and a high proportion of patients being in the lowest percentile for household income. Total hospital charge was highest in Hispanic patients. Despite higher rates of gastrointestinal bleed, Black patients were least likely to undergo left atrial appendage occlusion device implantation. Black and Hispanic patients were less like to undergo catheter ablation therapy. Black race was an independent predictor of mortality, stroke, mechanical ventilation, acute kidney injury, hemodynamic shock, need for vasopressor, upper GI bleed, need for blood transfusion, total hospital charges, and length of stay when compared to other groups. CONCLUSION Disparities exist in the risk of AF, and its management among racial and ethnic groups. Health care costs and inpatient outcomes disproportionately impact minorities in the United States.
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Affiliation(s)
- Laith Alhuneafat
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ahmad Jabri
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, Ohio, USA.
| | - Indu G Poornima
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Nada Alrifai
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Mustafa Ali
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Adee Elhamdani
- Department of Cardiology, Marshall University, Huntington, WV, USA
| | | | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Mohammed Mhanna
- Department of Cardiovascular Medicine, University of Iowa, Iowa City, IA, USA
| | - Faris Hadaddin
- Cardiovascular Medicine, Baylor college of medicine, Houston, TX, USA
| | - Muhammad Butt
- Department of Clinical Cardiac Electrophysiology, New York University Lagone, New York City, NY
| | | | - Saima Karim
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Ohad Ziv
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, Ohio, USA
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Thomas KL, Al-Khalidi HR, Silverstein AP, Monahan KH, Bahnson TD, Poole JE, Mark DB, Packer DL. Ablation Versus Drug Therapy for Atrial Fibrillation in Racial and Ethnic Minorities. J Am Coll Cardiol 2021; 78:126-138. [PMID: 34238436 DOI: 10.1016/j.jacc.2021.04.092] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Rhythm control strategies for atrial fibrillation (AF), including catheter ablation, are substantially underused in racial/ethnic minorities in North America. OBJECTIVES This study sought to describe outcomes in the CABANA trial as a function of race/ethnicity. METHODS CABANA randomized 2,204 symptomatic participants with AF to ablation or drug therapy including rate and/or rhythm control drugs. Only participants in North America were included in the present analysis, and participants were subgrouped as racial/ethnic minority or nonminority with the use of National Institutes of Health definitions. The primary endpoint was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. RESULTS Of 1,280 participants enrolled in CABANA in North America, 127 (9.9%) were racial and ethnic minorities. Compared with nonminorities, racial and ethnic minorities were younger with median age 65.6 versus 68.5 years, respectively, and had more symptomatic heart failure (37.0% vs 22.0%), hypertension (92.1% vs 76.8%, respectively), and ejection fraction <40% (20.8% vs 7.1%). Racial/ethnic minorities treated with ablation had a 68% relative reduction in the primary endpoint (adjusted hazard ratio [aHR]: 0.32; 95% confidence interval [CI]: 0.13-0.78) and a 72% relative reduction in all-cause mortality (aHR: 0.28; 95% CI: 0.10-0.79). Primary event rates in racial/ethnic minority and nonminority participants were similar in the ablation arm (4-year Kaplan-Meier event rates 12.3% vs 9.9%); however, racial and ethnic minorities randomized to drug therapy had a much higher event rate than nonminority participants (27.4% vs. 9.4%). CONCLUSION Among racial or ethnic minorities enrolled in the North American CABANA cohort, catheter ablation significantly improved major clinical outcomes compared with drug therapy. These benefits, which were not seen in nonminority participants, appear to be due to worse outcomes with drug therapy. (Catheter Ablation vs Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial [CABANA]; NCT00911508).
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Affiliation(s)
- Kevin L Thomas
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
| | | | - Adam P Silverstein
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | | | - Tristram D Bahnson
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Jeanne E Poole
- University of Washington Medical Center, Seattle, Washington, USA
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
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Ugowe FE, Jackson LR, Thomas KL. Racial and ethnic differences in the prevalence, management, and outcomes in patients with atrial fibrillation: A systematic review. Heart Rhythm 2018; 15:1337-1345. [PMID: 29803022 DOI: 10.1016/j.hrthm.2018.05.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Indexed: 01/26/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in the United States and is associated with increased morbidity, mortality, and health care expenditures. In this review, our aim was to assess the racial and ethnic differences in the epidemiology, management, and outcomes of patients with AF. A search of relevant studies from January 1, 2007, to December 30, 2017, was conducted in PubMed, EMBASE, and Web of Science and supplemented by manual searches of the bibliographies of retrieved articles. We identified 152 studies of which 64 were subsequently included. We found that underrepresented racial and ethnic groups have a higher prevalence of established risk factors associated with the development of AF but an overall lower incidence and prevalence of AF as compared with non-Hispanic whites. Moreover, racial and ethnic differences exist in detection, awareness, and AF-associated symptoms. Nonwhite populations also experience decreased use of rhythm control modalities and anticoagulation for stroke prevention. Lastly, among those with AF, underrepresented racial and ethnic groups had increased morbidity and mortality relative to white groups. Racial and ethnic differences exist in the prevalence, quality of life, management, and outcomes of individuals with AF; however, the mechanisms for these differences have yet to be fully elucidated. Racial and ethnic differences in AF warrant further analysis to understand the factors contributing to the differences in prevalence and management to ensure the delivery of high quality care that prevents stroke, reduces deaths, and decreases expenses associated with caring for underrepresented populations with AF.
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Affiliation(s)
| | - Larry R Jackson
- Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Kevin L Thomas
- Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
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