Rural-urban disparities in atrial fibrillation-related diagnostic testing and medical procedures in Canada
M Shurrab, W Mcintyre, C Cheung, O Haldenby, F Qiu, J Andrade, R Parkash, J Healey, D KoAbstract
Background
Rural–urban disparities in cardiovascular care are well documented, even within universal health care systems, but little is known regarding the extent to which geography influences access to atrial fibrillation (AF)-related care.
Purpose
This study evaluated rural–urban differences in the use of key diagnostic tests and medical procedures among patients presenting to the emergency department (ED) with AF.
Methods
We conducted a population-based retrospective cohort study of all adults (≥18 years) who presented with a primary diagnosis of AF to an ED in Ontario, Canada, between April 1, 2012, and March 31, 2022. The primary exposure was rural residence, defined as living in a community with a population of ≤10,000. Outcomes included diagnostic testing (electrocardiogram (ECG), echocardiogram, ambulatory ECG monitoring, and stress testing) and medical procedures (rhythm-control strategies [cardioversion or catheter ablation] and pacemaker or defibrillator implantation). Descriptive analyses were performed to compare rural and urban groups.
Results
Among 104,195 patients with AF presenting to the ED, 16,860 (16.2%) resided in rural communities. The mean age was 69.5 years in rural versus 69.4 years in urban groups, and women comprised 44.3% and 47.1%, respectively. Patients with AF presenting to the ED in rural Ontario had significantly lower rates of AF-related diagnostic testing compared with urban patients (ECG: 76.7% vs. 83.3%; echocardiogram: 65.3% vs. 68.8%; ambulatory ECG monitoring: 73.2% vs. 76.1%; stress testing: 25.8% vs. 30.3%; all p<0.001) within one year of ED presentation. Table 1. shows the rates of diagnostic testing within 30 days, 100 days, and one year. AF patients in rural areas also underwent fewer rhythm-control procedures (11.8% vs. 13.2%; p<0.001), while pacemaker or defibrillator implantation rates were similar (1.3% vs. 1.4%; p=0.21). Table 2. shows the rates of medical procedures within 100 days, and one year.
Conclusions
Despite universal health care coverage, substantial rural–urban disparities persist in the delivery of essential AF-related diagnostics and interventions. Targeted, system-level strategies are urgently needed to promote equitable access to cardiovascular care for rural populations.