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Updated: Jun 14, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Disparities in the access to atrial fibrillation ablation in Denmark: who gets ablated, who neglected?
Christopher R Zörner1, Jacob Tønnesen1, Lise Da Riis-Vestergaard1
1Department of Cardiology, Herlev-Gentofte University Hospital, University of Copenhagen, Gentofte Hospitalsvej 6, 2900 Hellerup, Denmark.
Insights
Men, younger patients, and those with higher education and employment are more likely to receive atrial fibrillation (AF) ablation. Women, older individuals, and those with lower socioeconomic status face disparities in AF ablation access.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Atrial fibrillation (AF) is a prevalent arrhythmia impacting quality of life and increasing stroke risk.
- Catheter ablation offers effective treatment for AF but equitable access remains a concern.
- Identifying demographic disparities in AF ablation is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate demographic factors influencing the likelihood of receiving atrial fibrillation ablation.
- To identify patient groups with reduced access to AF ablation procedures.
Main Methods:
- Analysis of nationwide Danish registry data from 2010-2018, including 176,248 patients with newly diagnosed AF.
- Multivariable Cox proportional hazard analysis to assess associations between demographics and ablation likelihood.
- Aalen-Johansen estimator for cumulative incidence calculation.
Main Results:
- Men (7%) were more likely to undergo ablation than women (3%).
- Ablation rates were highest in patients aged 25-64 and decreased significantly with age, with only 0.7% of those 80+ receiving it.
- Higher education and full-time employment correlated with increased likelihood of ablation, while retired patients had the lowest rates (3%).
Conclusions:
- Significant disparities exist in AF ablation access based on gender, age, education, and employment status in Denmark.
- Women, older patients, those with lower education, and individuals on social benefits are less likely to receive this treatment.
- Addressing these socioeconomic and demographic disparities is essential for equitable AF management.
Aims:
Atrial fibrillation (AF) is a common arrhythmia associated with reduced quality of life that can lead to serious complications such as stroke and heart failure. Ablation is a safe and effective treatment for AF but is not offered equally to all patients. The aim of this study is to identify demographic groups more or less likely to undergo AF ablation.
Methods And Results:
All patients with newly diagnosed AF between 2010 and 2018 were identified in the Danish nationwide registries. The association between gender, age, level of education and attachment to the job market, and the likelihood of receiving AF ablation was investigated using multivariable Cox proportional hazard analysis. Cumulative incidence was calculated using the Aalen-Johansen estimator. A total of 176 248 patients were included. Men were more likely to receive ablation than women (7% vs. 3%). Patients aged 25-44 and 45-64 were most likely to receive ablation, while only 0.7% of patients aged 80 or above received ablation. The rate of ablation significantly decreased with decreasing level of education. Full-time employed patients were most likely to receive ablation, followed by self-employed, unemployed, on sick leave, undergoing education, and early retired patients. Retired patients were the least likely to receive ablation (3%).
Conclusion:
This study found that women, older patients, patients with lower levels of education, and patients on social benefits are less likely to receive AF ablation. These findings suggest that there are significant social and economic disparities in AF ablation treatment in Denmark.
