Gender-specific effects of delay in cardiology consultation following primary care physician referral in atrial fibrillation patients: Impact on one-year outcomes

Abstract

Background and objectives

Over the last two decades, reductions in cardiovascular (CV) and cerebrovascular events for patients with atrial fibrillation (AF) have been observed, but the non-cardiovascular rates have increased. Early initiation of oral anticoagulation helps reduce AF complications; however, the impact of delayed cardiology care after referral by a Primary Care Physician (PCP) is unknown. The aim of our study is to investigate the association between the elapsed time to cardiology care following a PCP referral and one-year outcomes among patients with AF and analyses gender-specific differences in these outcomes.

Methods

All PCP referrals with previous AF diagnoses to cardiology consultation from 2010 to 2021 (N = 15,224) were analysed. The outcomes analysed were all-cause, CV, and stroke mortality and hospitalizations rates at one-year. Cox regression adjusted for age, sex, diabetes mellitus, hypertension, atrial fibrillation, peripheral arterial disease, and stroke analysed the risk associated with elapsed time. Odds ratios and 95 % confidence interval (OR [95 % CI]) were calculated.

Results

Delay time from PCP referral to cardiology care was associated with an increase per day of delay in all-cause (0.25 %), CV (0.13 %), HF (0.11 %) and stroke (0.14 %) mortality rates. Multivariate analyses showed that elapsed time was associated with a higher risk of all-cause (1.005 [1.003–1.007]), CV-mortalities (1.006 [1.005–1.007]), all-cause (1.005 [1.003–1.006]), and CV-hospitalizations (1.009 [1.006–1.012]). Gender-specific analyses revealed that men had higher all-cause mortality (5.3 % vs. 4.0 %, p < 0.001), while women exhibited higher stroke mortality (2.7 % vs. 1.5 %, p = 0.005) and haemorrhagic mortality (4.7 % vs. 3.2 %, p = 0.012). AF complications also increased with the delay time: stroke (1007 [1001−1013]), and cerebral haemorrhage (1008 [1005-1011]).

Conclusions

Elapsed time for cardiology care was associated with an increase in AF complications (stroke and haemorrhage), all-cause, CV-related mortality and hospitalizations rates at one-year. Gender differences were evident, with women demonstrating higher stroke and haemorrhagic mortality rates despite similar delays in care. These findings underscore the need for gender-tailored risk stratification and timely cardiology care to optimise outcomes.