Abstract 13123: Sex-Based Disparity in Referral for Catheter Ablation for Atrial Fibrillation at a Single Integrated Health System

Introduction: Catheter ablation for atrial fibrillation (AFCA) is indicated for patients with symptomatic AF and has proven to reduce AF burden and improve quality of life. Older studies have shown that women are less likely to undergo ablation compared to men despite having more AF-related symptoms. We investigated whether an association exists between referral patterns and this sex-based disparity in the modern era of AFCA.

Methods and Results: A retrospective cohort study was conducted of outpatients with newly diagnosed AF between 2011 and 2020 using an EMR database at Northwestern Medicine. Of 5,445 patients analyzed, 2,108 were women (mean [standard deviation, SD] age 70 [13], 19.2% non-Hispanic Black) and 3,337 were men (mean [SD] age 66 [13], 11.7% non-Hispanic Black). Other characteristics including insurance status, comorbidities, and prior treatment of AF were also compared by sex. Logistic regression models adjusted for these factors were constructed to determine associations between sex and a set of binary dependent variables including referrals to and visits with general cardiology and electrophysiology (EP) as well as performance of AFCA. In adjusted models, among internal medicine and primary care patients, there were no significant differences in odds of referral to or visits with general cardiology or EP between men and women. Additionally, there was no significant difference in odds to undergo AFCA between men and women once seen by EP (Figure).

Conclusions: Our study demonstrates no significant difference with respect to sex in referral patterns or performance of AFCA. Further work must be done to investigate whether these results are generalizable to other health systems regarding performance of AFCA as addressing these differences, when present, could prove essential in dismantling sex-based disparities in AF treatment.