Racial/ethnic and sex differences in safety outcomes and atrial fibrillation/atrial flutter–related acute healthcare utilization after catheter ablation of atrial fibrillation

BACKGROUND: Catheter ablation is recommended for the treatment of symptomatic atrial fibrillation (AF) refractory to medical therapy. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.