Temporal trends and racial disparities in atrial fibrillation ablation: A 5-year study

Abstract

Background

Racial disparities exist in access to cardiovascular interventions, including atrial fibrillation (AF) ablation. This study evaluates trends and disparities among racial and ethnic groups in the United States over a five-year period.

Methods

We conducted a cross-sectional analysis using the National Inpatient Sample (NIS) database from 2016 to 2020. Hospitalized AF patients undergoing ablation were identified using ICD-10 codes. Trends in ablation were assessed across racial groups, and multivariable logistic regression models were used to evaluate the predictors of cardiac ablation utilization. Time-to-ablation disparities were further analyzed using Cox proportional hazards regression.

Results

White patients had the highest ablation rates (1.08%) followed by Native Americans (1.03%), while Black patients had the lowest ablation rates (0.9%). A significant 52.6% increase in ablation utilization was observed over the study period (p < .001), yet racial disparities remained unchanged. Black (adjusted odds ratio (aOR) 0.61, 95% CI: 0.56–0.64) and Hispanic (aOR 0.83, 95% CI: 0.77–0.88) patients had significantly lower odds of undergoing AF ablation compared to White patients. Black patients with higher comorbid disease burden, severe obesity, and protein-calorie malnutrition were less likely to have AF ablation and experienced significant wait times (additional 1.3 days) before receiving ablation in time-to-procedure analysis.

Conclusions

While the overall rate of AF ablation has increased over time, persistent racial disparities in procedure utilization remain. Hospital location and bed size, socioeconomic factors, and comorbid medical conditions contribute to these disparities, underscoring the need for targeted interventions to close the gap in AF care.