Race, ethnicity may predict in-hospital outcomes after AF ablation in patients with HF
NEW ORLEANS — In patients with HF, race and ethnicity predicted the likelihood of in-hospital mortality and other outcomes after ablation for atrial fibrillation, researchers reported.
The findings were presented at the American College of Cardiology Scientific Session and simultaneously published in JACC: Clinical Electrophysiology.
Data were derived from Agarwal S, et al. Abstract 1028-03. Presented at: American College of Cardiology Scientific Session; March 4-6, 2023; New Orleans (hybrid meeting).
“Racial differences exist in the in-hospital outcomes after atrial fibrillation ablation in patients with heart failure with both reduced and preserved ejection fraction, with minorities having higher in-hospital mortality, cardiovascular complications and longer length of stay,” Stavros Stavrakis, MD, PhD FACC, FHRS, a cardiologist at the Heart Rhythm Institute of the University of Oklahoma Health Sciences Center and associate professor of medicine at the University of Oklahoma College of Medicine in Oklahoma City, told Healio. “Recognizing these disparities is the first step to eliminate them. It is possible that implicit bias among the members of the health care community might contribute to these disparities, resulting in delayed referral for ablation, which in turn leads to worse outcomes.”
Stavrakis and colleagues analyzed data from 61,110 adults with HF who were admitted for AF ablation from 2016 to 2019, using information from the National Inpatient Sample database. Researchers stratified patients as white, Black, Hispanic and other races, and assessed baseline characteristics and discharge data.
Within the cohort, 20,085 patients had HF with preserved ejection fraction (81% white; 8.4% Black; 5.3% Hispanic and 2.8% other races) and 41,025 patients had HF with reduced EF (75.9% white; 14.1% Black; 6.1% Hispanic and 3.8% other races).
Among patients with HFpEF, compared with white adults, Black adults had higher odds for in-hospital mortality (adjusted OR = 3.3; 95% CI, 1.7-6.4; P < .01) and CV complications (aOR = 1.56; 95% CI, 1.03-2.35; P = .03), as well as longer length of hospital stay (adjusted mean difference, 1 day longer; 95% CI, 0.2-1.9; P < .01).
Compared with white patients, Hispanic patients had higher hospitalization charges (adjusted mean difference, $6,707; 95% CI, 1,803-10,256; P = .01), as did patients of other races (adjusted mean difference, $7,348; 95% CI, 1,387-13,309; P = .01).
Among patients with HFrEF, those classified as identifying from other races experienced nearly twice higher odds for in-hospital mortality compared with white patients (aOR = 1.98; 95% CI, 1.06-3.7; P = .03), as well as a longer length of stay (adjusted mean difference, 1.5 days; P = .03) and higher hospitalization charges (adjusted mean difference, $5,658; 95% CI, 1,013-11,380; P = .03), whereas Black patients had lower odds for vascular complications (aOR = 0.42; 95% CI, 0.23-0.76; P < .01) and experienced a longer length of stay (adjusted mean difference, 1 day; P = .03) vs. white patients.
“There are several potential explanations for our findings,” the researchers wrote in the simultaneous publication. “First, in our cohort of patients, the burden of comorbidities was higher among the racial/ethnic minorities when compared with whites and could have affected results. Even though analyses were adjusted for and independent of these comorbidities, unmeasured confounders could still exist. Second, the presence of implicit bias among the members of the health care community might contribute to these disparities, resulting in delayed referral for AF ablation, which in turn leads to worse outcomes.”
Stavrakis told Healio that further research is needed to understand the cause of these differences and identify ways to minimize disparities.
Reference:
Collapse
Agarwal S, et al. Abstract 1028-03. Presented at: American College of Cardiology Scientific Session; March 4-6, 2023; New Orleans (hybrid meeting).
Read more about