Centre-Specific Variation in Atrial Fibrillation Ablation-Treatment Rates in a Universal Single-Payer Healthcare...

Area of Science:

• Cardiology
• Electrophysiology
• Health Services Research

Background:

• Previous studies on atrial fibrillation (AF) ablation disparities focused on patient or system factors, neglecting geographic influences.
• The impact of electrophysiology (EP) center practice patterns on AF ablation rates remains understudied.

Purpose of the Study:

• To investigate the association between geographic proximity to EP centers and AF ablation rates.
• To determine if EP center location influences ablation treatment decisions beyond patient characteristics and distance.

Main Methods:

• Population-based cohort study using linked administrative data (physician billing, hospitalizations, prescriptions, census) in Ontario, Canada (2007-2016).
• Included patients with a new emergency department diagnosis of atrial fibrillation.
• Multivariable logistic regression analyzed the relationship between living near specific EP centers and ablation rates, controlling for patient demographics, comorbidities, and socioeconomic factors.

Main Results:

• The cohort comprised 134,820 patients, with 9,267 undergoing ablation.
• Patients receiving ablation were younger, had lower CHADS2 scores, fewer comorbidities, and lived closer to EP centers.
• Significant variations in ablation rates were observed, with rates up to 2.6 times higher in adjacent census divisions. Living near specific EP centers showed odds ratios ranging from 0.78 to 1.60, indicating significant geographic disparities.

Conclusions:

• Proximity to specific EP centers is a significant factor influencing a patient's likelihood of receiving AF ablation.
• These geographic disparities persist irrespective of patient age, gender, socioeconomic status, medical history, or absolute distance to an EP center.