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Introduction:Non-Hispanic Black (NHB) adults with atrial fibrillation (AF) are less likely to undergo catheter ablation (AFCA) compared with non-Hispanic White (NHW) adults even among those with heart failure and even though previous studies have shown that NHB patients with AF were more symptomatic.Hypothesis:We hypothesize that differences in outpatient referrals to Cardiology and Electrophysiology (EP) contribute to the racial disparity in AFCA.Methods:Using data from the Northwestern Medicine Enterprise Data Warehouse, we curated a retrospective cohort of NHB and NHW patients with newly diagnosed AF between 1/1/2011 and 12/31/2019 in an outpatient office visit to Internal Medicine/Primary Care (IM/PC), Cardiology, or Heart Failure (HF). Rates of AFCA and referral rates from IM/PC to Cardiology or EP and from Cardiology and HF to EP were compared between NHB and NHW patients using logistic regression models adjusted for demographic characteristics and comorbidities.Results:Of the 5,555 included patients, the mean age was 68 years (SD 13.4), 61% were male, 15% were NHB, and the mean CHA2DS2-VASc score was 3.5 (SD 2.0). 373 patients (6.7%) underwent AFCA. NHB patients had a higher prevalence of comorbidities. NHB patients were significantly less likely to undergo AFCA compared with NHW patients (OR 0.61, 95% CI 0.40-0.92, p= 0.02), and this difference persisted even when limited to the subset of patients who had visited EP (N=1,840, OR 0.65, CI 0.42-0.98, p= 0.04). Among patients diagnosed in IM/PC, NHB patients were 1.47 times more likely to be referred to Cardiology than NHW patients (CI 1.09-1.97, p= 0.01), but the rates of referral to EP were similar (OR 0.94, CI 0.72-1.24, p= 0.68) (Figure).Conclusion:NHB patients diagnosed in the outpatient setting are less likely to undergo AFCA compared with NHW patients, but referral patterns do not explain these findings. Exploration of other factors should be considered to mitigate disparities in care related to AFCA. |
