Inequitable Access to Catheter Ablation for Atrial Fibrillation and Adverse Outcomes in a Publicly Funded Healthcare System.

BACKGROUND

Although all Canadians have universal coverage for hospital-based care, only limited data describe the determinants of access to catheter ablation for atrial fibrillation (AF) in Canada.

METHODS

This population-based cohort study from Alberta, Canada (2013-2020) included adults (age ≥ 18 years) with new-onset AF in whom a rhythm-control strategy was desired. Factors associated with ablation within 5 years were identified using multivariable logistic regression models. The association between ablation and outcomes was assessed in a propensity score-matched cohort using Cox proportional hazard models; the time to ablation was treated as a time-varying covariate to mitigate immortal time bias.

RESULTS

Of 11,844 patients, 8.7% (n = 1014) received ablation within 5 years of diagnosis. The mean cohort age was 64.6 ± 14.0 years; 35.1% were female; and the mean Chronic Heart Failure, Hypertension, Age ≥ 75 Years, Diabetes Mellitus, Stroke, Vascular Disease, Age 65 to 74 Years, Sex Category (CHA2DS2-VASc) score was 2.6 ± 1.9. Patients were less likely to receive ablation if they were older, were female, or had hypertension, heart failure, or kidney disease. Ablation was more common in patients with higher socioeconomic status. In the propensity score-matched cohort, ablation was associated with a lower risk of AF recurrence (hazard ratio [HR] 0.59; 95% confidence interval 0.48-0.72; P < 0.001) and a nonstatistically significant lower risk of all-cause mortality (HR 0.63; 95% CI 0.38-1.03; P = 0.06).

CONCLUSION

There are disparities in ablation rates based on demographic and socioeconomic factors. Lack of access to ablation is associated with poorer clinical outcomes at 5 years. Our results support the importance of equity-driven health services planning and advocacy to ensure fair access to ablation.