Gender, Race, and Health Insurance Status in Patients Undergoing Catheter Ablation for Atrial Fibrillation

Patel, Nileshkumar; Deshmukh, Abhishek; Thakkar, Badal; Coffey, James O.; Agnihotri, Kanishk; Patel, Achint; Ainani, Nitesh; Nalluri, Nikhil; Patel, Nilay; Patel, Nish; Patel, Neil; Badheka, Apurva; Kowalski, Marcin; Hendel, Robert C.; Viles-González, Juan F.; Noseworthy, Peter A.; Asirvatham, Samuel J.; Lo, Kaming; Myerburg, Robert J.; Mitrani, Raul D.

doi:10.1016/j.amjcard.2016.01.040

Cited by 91 publications

(64 citation statements)

References 26 publications

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“…Selection of appropriate patients is a complex process that requires careful consideration of clinical factors including symptoms, presence of heart disease, obesity, sleep apnoea, left atrial size, duration of persistent AF, and patient preferences 44 . A few large administrative registries have reported that, after multivariable adjustments, women are less likely to undergo catheter ablation than men 34,45 , and that women are underrepresented in catheter ablation meta-analyses 46–49 . A review on the association between sex and outcomes of catheter ablation for AF has also reported that women are referred less often and later than men 50 .…”

Section: Rate and Rhythm Controlmentioning

confidence: 99%

Atrial fibrillation in women: treatment

Rahman

Martins

et al. 2016

Nat Rev Cardiol

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Sex-specific differences in the epidemiology, pathophysiology, presentation, prognosis, and treatment of atrial fibrillation (AF) are increasingly recognized. Women with AF generally experience worse symptoms, poorer quality of life, and have higher risk of stroke and death than men with AF. Effective treatment of the arrhythmia in women is critical to reduce the rate of adverse events. We review the current evidence on sex-specific differences in the utilization and outcomes of treatments for AF, including rate-control and rhythm-control strategies, and stroke-prevention therapy. In addition, we provide a critical evaluation of potential disparities and biases in health-care use that may be associated with differences in the outcomes between women and men.We underscore current knowledge gaps that need to be addressed in future studies to improve the management of AF in women. In particular, we suggest several strategies to produce quality evidence from randomized, clinical trials for women with AF.

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Section: Rate and Rhythm Controlmentioning

confidence: 99%

Atrial fibrillation in women: treatment

Rahman

Martins

et al. 2016

Nat Rev Cardiol

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“…Further, there is a significant racial disparity in use of CA as a treatment modality in patients with AF. Compared to whites, black and Hispanic patients have a lower rate of CA when hospitalized for AF . These race and gender differences persist despite correcting for age, medical comorbidities, and income.…”

Section: Introductionmentioning

confidence: 97%

“…Pulmonary vein isolation by CA has been demonstrated to be an effective treatment to restore and maintain normal sinus rhythm in patients with AF . Women with AF, however, are generally treated less aggressively with fewer cardioversions and CA . Recent studies have differed in answering whether women have similar or higher long‐term AF recurrence rates after CA, with the matter yet to be definitively settled .…”

Section: Introductionmentioning

confidence: 99%

Impact of race and gender on clinical outcomes of catheter ablation in patients with atrial fibrillation

Bukari

Nayak

Aziz

et al. 2017

Pacing Clinical Electrophis

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Background Radiofrequency catheter ablation (CA) is an effective treatment of drug-refractory atrial fibrillation (AF). However, the efficacy of CA by race and gender has not been well characterized. We sought to determine the impact of ethnicity and gender on clinical outcome following CA in patients with AF. Methods Patients who underwent CA for AF from September 2013 to April 2016 were included in this study. Patients were identified retrospectively and followed prospectively. Results A total of 118 patients (15.3% black and 78.8% white, 33% female) comprised the cohort, with mean age at ablation 63.4 +/− 10.4 years. Black patients were older at time of the procedure (65.4 vs 63.4 years old) and had more prevalent comorbidities, including hypertension (77.8 vs 63.4%), diabetes (33.3 vs 15.0%), chronic kidney disease (22.2 vs 7.5%) and lower left ventricular ejection fraction (51.8 vs 56.2%). Blacks also had significantly larger left atrial size (p=0.03). Late recurrence of AF was similar between blacks and whites (33.3 vs 34.4%, p=1) as well as between women and men (28.2 vs 36.7%, p=0.41). Early recurrence was predictive of late recurrence in men (p<0.001) but not in women (p=0.48). Enlarged left atrium and early recurrence of AF were significant predictors for late recurrence of AF in the cohort. Conclusions CA for AF is equally effective in black patients despite more prevalent co-morbidity and increased left atrial size. Early recurrence of AF after CA was not predictive of late recurrence of AF in women but was in men.

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“…Although the age adjusted prevalence of atrial fibrillation (AF) is higher in men when compared to women, the absolute number of men and women with this condition is similar as the majority of AF occurs between 65 and 85 years of age, a time where proportionately more women than men are alive . Unfortunately, population based studies in various jurisdictions have consistently demonstrated a lower rate of referral for AF ablation in women compared to men . The reason for this is unclear and may be related to perceived gender differences in the safety and efficacy of catheter ablation for AF .…”

Section: Introductionmentioning

confidence: 99%