Racial/ethnic minority groups less likely to receive optimal treatment for paroxysmal AF
Rhythm control strategies to treat paroxysmal atrial fibrillation were less common among racial/ethnic marginalized individuals than among white individuals, a cohort study published in JAMA Network Open found.
“Among patients with heart failure, catheter ablation for atrial fibrillation has been shown to decrease mortality and heart failure hospitalizations,” Lauren A. Eberly, MD, MPH, cardiovascular fellow at the Perelman School of Medicine, the Center for Cardiovascular Outcomes Quality and Evaluative Research and the Penn Cardiovascular Center for Health Equity and Social Justice at the University of Pennsylvania, told Healio. “Unfortunately, as we know, our health care system is fraught with inequity and structural racism is pervasive. Decreased adoption of novel cardiovascular therapeutics among Black, Latinx and patients of lower socioeconomic status has been repeatedly demonstrated.”
The study included 109,221 adult patients (51% men; 67% white; median age, 75 years) with a diagnosis of incident paroxysmal AF from the Optum Clinformatics Data Mart from October 2015 to June 2019. Researchers obtained inpatient, outpatient and pharmacy claims data to evaluate the association of racial/ethnic and ZIP code-linked median household income with rhythm control strategies such as antiarrhythmic drugs or catheter ablation vs. a rate control strategy. Researchers also analyzed catheter ablation use vs. antiarrhythmic drug use among patients receiving rhythm control strategies.
Rhythm control usage
Among the cohort, 79.1% of patients were treated with rate control, 17.7% were treated with antiarrhythmic drugs and 3.2% were treated with catheter ablation. There was an increase in the percentage of patients treated with catheter ablation from 1.6% to 3.8% from 2016 to 2019.
Black race compared with white race (adjusted OR = 0.89; 95% CI, 0.83-0.94; P < .001), lower ZIP code-linked median household income of less than $50,000 compared with $100,000 or more (aOR = 0.83; 95% CI, 0.79-0.87; P < .001) and lower ZIP code-linked median household income of $50,000 to $99,999 compared with $100,000 or more (aOR = 0.92; 95% CI, 0.88-0.96; P < .001) were all associated with reduced odds of receiving rhythm control therapy.
Among all patients who received rhythm control, Latinx ethnicity compared with non-Latinx ethnicity (aOR = 0.73; 95% CI, 0.6-0.89; P = .002) and ZIP code-linked median household income of less than $50,000 (aOR = 0.61; 95% CI, 0.54-0.69; P < .001) and $50,000 to $99,999 compared with $100,000 or more (aOR = 0.81; 95% CI, 0.72-0.9; P < .001) were independently associated with lower catheter ablation use.
“We encourage leadership at institutions to declare health equity as a top priority and think about ways in which these inequities can be addressed within their own walls and beyond,” Eberly said in an interview. “In order to achieve health equity, we must redesign the systems and structures of our health care system to prioritize those who have been historically marginalized.”
Structural inequities
According to Eberly, these results reflect deep structural inequities in the American health care system and are consistent with prior studies demonstrating the presence of structural racism and inequities in CV therapeutics.
“Given recent evidence demonstrating improved cardiovascular outcomes with early rhythm control treatment, we hope awareness will push primary care providers and noncardiac providers to more readily consider rhythm control strategies or referral to a specialist, particularly for those patients who have been historically marginalized by the health care system,” Eberly said. “Further studies to better understand barriers to these therapies and ensuring equitable access to all AF therapies are paramount.”
For more information:
Lauren A. Eberly, MD, MPH, can be reached at lauren.eberly@pennmedicine.upenn.edu.
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