Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL.
Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.
J Am Heart Assoc. 2022 Sep 20;11(18):e025831. doi: 10.1161/JAHA.122.025831. Epub 2022 Sep 8.
Background Guidelines recommend catheter ablation of atrial fibrillation (AFCA) as an option for rhythm control. Studies have shown that Black patients are less likely to undergo AFCA compared with White patients. We investigated whether differences in referral patterns play a role in this observed disparity. Methods and Results Using an integrated repository from the electronic medical record at Northwestern Medicine, we conducted a retrospective cohort study of outpatients with newly diagnosed atrial fibrillation. Baseline characteristics by race and ethnicity were compared. Logistic regression models adjusted for socioeconomic and health factors were constructed to determine the association between race and ethnicity and binary dependent variables including referrals and visits to general cardiology and cardiac electrophysiology (EP) and AFCA. Of 5445 patients analyzed, 4652 were non-Hispanic White (NHW) and 793 were non-Hispanic Black (NHB). In adjusted models, NHB patients initially diagnosed with atrial fibrillation in internal medicine and primary care had a significantly greater odds of referral to general cardiology; among all patients in the cohort, there was no significant difference in the odds of referral to EP between NHB and NHW patients; and there were no differences in the odds of completing a visit in general cardiology or EP. Among patients completing an EP visit, NHB patients were less likely to undergo AFCA (odds ratio, 0.63 [95% CI, 0.40-0.98], =0.040). Conclusions Similar referral rates to general cardiology and EP were observed between NHB and NHW patients. Despite this, NHB patients were less likely to undergo AFCA.
背景 指南建议导管消融（AFCA）作为节律控制的一种选择。研究表明，与白人患者相比，黑人患者进行 AFCA 的可能性较低。我们研究了转诊模式的差异是否在这种观察到的差异中起作用。
方法和结果 我们使用西北医学电子病历的综合存储库，对新诊断为心房颤动的门诊患者进行了回顾性队列研究。按种族和民族比较基线特征。构建了调整社会经济和健康因素的逻辑回归模型，以确定种族和民族与包括转诊和普通心脏病学和心脏电生理学（EP）就诊以及 AFCA 在内的二项因变量之间的关联。在分析的 5445 名患者中，4652 名是非西班牙裔白人（NHW），793 名是非西班牙裔黑人（NHB）。在调整后的模型中，最初在内科和初级保健中诊断为心房颤动的 NHB 患者转诊至普通心脏病学的可能性显著更高；在队列中的所有患者中，NHB 和 NHW 患者转诊至 EP 的可能性之间没有显著差异；并且在普通心脏病学或 EP 就诊的可能性方面没有差异。在完成 EP 就诊的患者中，NHB 患者进行 AFCA 的可能性较低（优势比，0.63 [95%CI，0.40-0.98]，=0.040）。
结论 NHB 和 NHW 患者接受普通心脏病学和 EP 转诊的比率相似。尽管如此，NHB 患者进行 AFCA 的可能性较低。
