Racial/Ethnic and Socioeconomic Disparities in Management of Incident Paroxysmal Atrial Fibrillation

Abstract

IMPORTANCE In patients with paroxysmal atrial fibrillation (AF), rhythm control with either antiarrhythmic drugs (AADs) or catheter ablation has been associated with decreased symptoms, prevention of adverse remodeling, and improved cardiovascular outcomes. Adoption of advanced cardiovascular therapeutics, however, is often slower among patients from racial/ethnic minority groups and those with lower income. OBJECTIVE To ascertain the cumulative rates of AAD and catheter ablation use for the management of paroxysmal AF and to investigate for the presence of inequities in AF management by evaluating the association of race/ethnicity and socioeconomic status with their use in the United States. DESIGN, SETTING, AND PARTICIPANTS This cohort study obtained inpatient, outpatient, and pharmacy claims data from the Optum Clinformatics Data Mart between October 1, 2015, and June 30, 2019. Adult patients (aged Ն18 years) in the database with a diagnosis of incident paroxysmal AF were identified. Patients were excluded if they did not have continuous insurance enrollment for at least 1 year before and at least 6 months after study entry. EXPOSURES Race/ethnicity and zip code-linked median household income. MAIN OUTCOMES AND MEASURES Treatment with a rhythm control strategy, and catheter ablation specifically, among those who received rhythm control. Multivariable logistic regression models were used to assess the association of race/ethnicity and zip code-linked median household income with a rhythm control strategy (AADs or catheter ablation) vs a rate control strategy as well as with catheter ablation vs AADs among those receiving rhythm control. RESULTS Of the 109 221 patients who met the inclusion criteria, 55 185 were men (50.5%) and 73 523 were White (67.3%), with a median (interquartile range) age of 75 (68-82) years. A total of 86 359 patients (79.1%) were treated with rate control, 19 362 patients (17.7%) with AADs, and 3500 (3.2%) with catheter ablation. Between 2016 and 2019, the cumulative percentage of patients treated with catheter ablation increased from 1.6% to 3.8%. In multivariable analyses, Black race

Racial and Ethnic Differences in the Management of Atrial Fibrillation

“…Studies utilizing these registries have demonstrated that Black and Hispanic patients were less likely to receive rhythm control or catheter ablation than White patients despite the presence of symptoms. 39,41 A recent meta-analysis reported similar rates of AV node ablation but lower rates of AF ablation among Black patients compared with White patients. 18 In the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) randomized clinical trial, 90.1% of patients were White and only 6.6% and 3.3% patients were Black and Hispanic respectively.…”

“…Factors such as socioeconomic status and lack of supplemental insurance coverage, as well as documented sex- and race-based differences in preferences related to medical care, might contribute to delays in diagnosing AF. 41 Lack of health literacy may limit patient engagement and impact decisions for treatment of AF. Non-White patients and those with a lower education level have been shown to be less likely to receive care from a cardiologist for AF.…”

“…Studies utilizing these registries have demonstrated that Black and Hispanic patients are less likely than White patients to receive rhythm-control or catheter-ablation treatment, despite the presence of symptoms. 39 , 41 A recent meta-analysis reported similar rates of atrioventricular node ablation but lower rates of AF ablation among Black patients, compared with White patients. 18 …”

“…The findings were consistent with those of prior studies; compared with White patients, Black patients were significantly less likely to be treated with rhythm control (adjusted odds ratio 0.89 [95% CI 0.83-0.94], P < 0.001), and those of Latino ethnicity were significantly less likely to undergo catheter ablation. 41 Data from the PINNACLE/NCDR registry were utilized to assess AF management among American Indian and Alaskan Native patients. These patients were significantly less likely to be treated with rhythm-control strategies, compared with non-American Indian/Alaskan Native patients.…”

Lixarit — clinical and pharmaceutical aspects of efficacy and safety of flecainide acetate generic drug

“…Сьогодні на українському фармацевтичному ринку цей антиаритмічний засіб представляють декілька виробників, що ставить перед лікарем проблему вибору оптимального препарату. І економічні аспекти фармакотерапії мають не менше значення, ніж клінічні, а для значної частини пацієнтів є ключовим фактором прихильності до лікування [20]. З урахуванням цього факту препаратом вибору серед аналогів, що містять ту саму діючу речовину, повинен бути якісний генерик, що не поступається оригінальному препарату за клінічною ефективністю і безпекою, але більш доступний.…”