Abstract P1166: Sex-Based Disparities in the Referral Pathway for Catheter Ablation for Atrial Fibrillation in a Large Urban Healthcare System

Abstract

Background: The prevalence of atrial fibrillation is reported to be lower in women, however it remains unclear if this is a biological phenomenon or social construct representative of limited access to healthcare resources. Catheter ablation (CA) is considered first line therapy for patients with symptomatic atrial fibrillation; however, women are less likely to be referred, and when referred are older, with more advanced disease and comorbidities. To elucidate barriers in access to catheter ablation for women, we will assess potential bottlenecks in the AF referral pathway. Methods: Leveraging the large and highly diverse patient population of a large healthcare system the incidence of patients diagnosed with AF between 2015-2023 were established, and time from diagnosis to ablation was calculated. Cox proportional hazard regression analysis was performed to assess sex-specific differences in time from AF diagnosis to ablation. Kaplan Meier survival curves were generated. Results: Between 2015 and 2023, 31,186 female and 41,789 male patients were diagnosed with AF, 1,952(6.3%) and 3,751(9.0%) underwent catheter ablation, respectively. Female patients undergoing CA were significantly older (67.9±9.9 years vs 63.7±10.3, p<0.001) although more likely to be paroxysmal (41.0% vs 35.3%, p<0.00) compared to males. Over the study period, female patients were less likely to undergo catheter ablation following diagnosis of AF (HR 0.93, 95% CI 0.88-0.98, p=0.017) when adjusting for age. The rate of referral for electrophysiology consult [(Females: 68.1% vs Males: 61.5%, p<0.001) Figure 1 Panel A]. was similar, as well as the time from diagnosis to catheter ablation between groups (Males: 591± 804 days vs Females: 613± 822, p=0.37). Kaplan-Meier curve shows the divergence between male and female patients, indicating a higher rate of ablation procedures performed for males [(log rank p<0.001), Figure 1 Panel B]. Conclusion: Over an 8-year follow-up period, in a large urban healthcare system, while women were more likely to be referred for electrophysiology consult, they were less likely to undergo catheter ablation. Further investigation is needed to assess potential barriers to design evidence-based intervention to reduce this disparity.