Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation

Abstract

BACKGROUND Atrial fibrillation (AF) is associated with an increased risk of stroke and death. Uniform utilization of appropriate therapies for AF may help reduce those risks. OBJECTIVE We sought to determine whether significant race and sex differences exist in the treatment of newly diagnosed AF in Medicare beneficiaries. METHODS We used administrative encounter data for Medicare beneficiaries to identify patients with newly diagnosed AF during 2010–2011. Services received after initial AF diagnosis were cataloged, including visits with a cardiologist or electrophysiolo-gist, catheter ablation procedures, and use of oral anticoagulants, rate control agents, and antiarrhythmic drugs. RESULTS Overall, 517,941 patients met study criteria, of whom 452,986 (87%) were white, 36,425 (7%) black, and 28,530 (6%) Hispanic. Male patients comprised 209,788 (41%) of the cohort. In multivariate analysis, there were statistically significant differences in the use of AF-related services by both race and sex, with white patients and male patients receiving the most care. The most notable disparities were for catheter ablation (Hispanic vs white: adjusted hazard ratio [AHR] 0.70; 95% confidence interval [CI] 0.63–0.79; P < .001; female vs male: AHR 0.65; 95% CI 0.63–0.68; P < .001) and receipt of oral anticoagulation (black vs white: AHR 0.94; 95% CI 0.92–0.95; P < .001; Hispanic vs white: AHR 0.94; 95% CI 0.93–0.97; P < .001; female vs male: AHR 0.93; 95% CI 0.93–0.94; P < .001). CONCLUSION Race and sex appear to have a significant effect on the health care provided to this cohort of Medicare beneficiaries diagnosed with AF. Possible explanations include racial differences in access, patient preferences, treatment bias, and unmeasured clinical characteristics.

Gender differences in management and clinical outcomes of atrial fibrillation patients

“…Despite their higher risk of stroke and higher CHADS 2 scores, women were less likely to be on anticoagulation, which may have contributed to increased mortality. Although other studies have documented the lower anticoagulation rates and higher rates of stroke in women with AF in the USA and Canada [11,18,19], no studies have been able to identify the exact cause of this disparity. It has been speculated that older women are more often at risk of falling, which is why they are less likely to be prescribed anticoagulation therapy.…”

“…In fact, procedural pursuit of rhythm management in men was evident through the higher rates of electrical cardioversion, AF ablations, and maze surgeries compared to women. A recent study looking at new onset AF in >500,000 Medicare beneficiaries found similar disparities in the treatment of AF by gender with men having higher rates of AF ablations [18]. It is not clear why women are less likely to receive AF ablation since current guidelines recommend AF ablation as a viable first-line treatment option for patients with paroxysmal AF regardless of gender [25].…”

Sex-related outcome of atrial fibrillation ablation: Insights from the German Ablation Registry

“…[7][8][9]12,13,14 The underlying reason remains to be determined and may be due to physicians' bias or women's reluctance to undergo an invasive procedure as an early treatment option. In this cohort, fewer women received CA although centers were asked to recruit consecutive patients.…”

Atrial Fibrillation and Ventricular Arrhythmias

“…48 Although AF ablation has increased over the past decade, several large administrative registries from Canada and the United States have reported that, in comparison with men, women are substantially less likely to undergo catheter ablation for AF. [49][50][51] Women are older at the time of AF ablation and are referred for the procedure later following presentation than men.…”