Social Determinants of Health and Disparities in Diagnosis-to-Ablation Time for Atrial Fibrillation.

Abstract

Background: Social determinants of health (SDOH) significantly influence health care access and outcomes, but their impact on atrial fibrillation (AF) diagnosis-to-ablation time (DAT) and anticoagulation prescription rates is unknown.

Objective: The goal of this study was to assess the associations between SDOH, measured by using the Area Deprivation Index (ADI), and DAT and anticoagulation prescription rates in patients undergoing AF ablation.

Methods: Data from the Hopkins AF Ablation Registry (2014-2023) were analyzed retrospectively. The relationship between ADI and DAT was evaluated by using log-gamma regression analysis, adjusting for age, sex, race, and comorbidities. Restricted cubic spline analysis was used to qualitatively assess the linearity of the associations. For anticoagulation prescription rates, only patients who qualified for therapy were included, and logistic regression was used to assess the association between ADI and anticoagulant prescription at discharge, adjusting for the same covariates.

Results: After excluding patients with missing data, 1,025 patients undergoing first AF ablation were included. Higher ADI scores, indicating greater SDOH burden, were significantly associated with longer DAT. Each 10-unit increase in ADI percentile corresponded to a 6.96% increase in DAT (95% CI: 1.02-1.12; P = 0.003), equating to a delay of 3.83 months (95% CI: 1.27-6.39). Restricted cubic spline revealed a linear relationship between ADI and DAT. Subgroup analyses did not show any significant interactions by age group, sex, or race. No significant association was found between ADI percentile and anticoagulant prescription at discharge (P = 0.097).

Conclusions: Greater SDOH burden is associated with significant delays in accessing AF ablation. Addressing socioeconomic barriers is essential to ensure equitable and timely AF care.