Jackson Larry R, Friedman Daniel J, Francis Diane M, Maccioni Sonia, Thomas Vincent C, Wood Jennifer, Khanna Rahul, Wong Charlene, Rahai Neloufar, Piccini Jonathan P
Department of Internal Medicine, Adult Cardiac Electrophysiology Section, Duke University Medical Center, Durham, North Carolina.
Health Economics and Market Access, Johnson & Johnson Medical Devices, Irvine, California.
Heart Rhythm O2. 2023 Feb 16;4(5):291-297. doi: 10.1016/j.hroo.2023.02.005. eCollection 2023 May.
Catheter ablation is recommended for the treatment of symptomatic atrial fibrillation (AF) refractory to medical therapy.
The study sought to examine racial/ethnic and sex differences in complications and AF/atrial flutter (AFL)-related acute healthcare utilization following catheter ablation for AF.
We performed a retrospective analysis using data from the Centers for Medicare and Medicaid Services Medicare Standard Analytical Files (October 1, 2014, to September 30, 2019) among patients ≥65 years of age with AF who underwent catheter ablation for rhythm control. The risk of any complication within 30 days and AF/AFL-related acute healthcare utilization within 1 year of ablation by race, ethnicity, and sex were assessed using multivariable Cox regression modeling.
We identified 95,394 patients for analysis of postablation complications and 68,408 patients for analysis of AF/AFL-related acute healthcare utilization. Both cohorts were ∼95% White and 52% male. Female patients had a slightly elevated risk of complications compared with male patients (adjusted hazard ratio [aHR] 1.07, 95% confidence interval [CI] 1.03-1.12). Black (aHR 0.78, 95% CI 0.77-1.00) and Asian (aHR 0.67, 95% CI 0.50-0.89) patients had lower utilization compared with White patients. Specifically, Asian men (aHR 0.58, 95% CI 0.38-0.91) had lower utilization compared with White men.
Differences in safety and healthcare utilization after catheter ablation for AF were observed by race/ethnicity and sex groups. Underrepresented racial and ethnic groups with AF had a lower risk of AF/AFL-related acute healthcare utilization postablation.
对于药物治疗无效的症状性心房颤动（AF），推荐采用导管消融术进行治疗。
本研究旨在探讨AF导管消融术后并发症以及与AF/心房扑动（AFL）相关的急性医疗资源利用方面的种族/民族和性别差异。
我们使用医疗保险和医疗补助服务中心医疗保险标准分析文件（2014年10月1日至2019年9月30日）的数据，对年龄≥65岁、因节律控制接受导管消融术的AF患者进行了回顾性分析。采用多变量Cox回归模型评估种族、民族和性别在消融后30天内发生任何并发症的风险以及消融后1年内与AF/AFL相关的急性医疗资源利用情况。
我们确定了95394例患者用于分析消融后并发症，68408例患者用于分析与AF/AFL相关的急性医疗资源利用情况。两个队列中约95%为白人，52%为男性。与男性患者相比，女性患者发生并发症的风险略有升高（调整后风险比[aHR]为1.07，95%置信区间[CI]为1.03 - 1.12）。与白人患者相比，黑人（aHR为0.78，95% CI为0.77 - 1.00）和亚洲人（aHR为0.67，95% CI为0.50 - 0.89）的医疗资源利用率较低。具体而言，与白人男性相比，亚洲男性（aHR为0.58，95% CI为0.38 - 0.91）的医疗资源利用率较低。
在AF导管消融术后，不同种族/民族和性别组在安全性和医疗资源利用方面存在差异。AF患者中代表性不足的种族和民族群体在消融后发生与AF/AFL相关的急性医疗资源利用的风险较低。
