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Racial Differences in Length of Stay After Atrial Fibrillation Ablation
Waseem Nosair1,2, Yasmina Sirgi1, Evan Czulada1
1School of Medicine, Georgetown University, Washington, District of Columbia, USA.
Insights
Non-Hispanic Black patients undergoing catheter ablation for atrial fibrillation experienced longer hospital stays. Factors beyond complications, such as comorbidity burden and social determinants of health, contribute to these disparities.
Area of Science:
- Cardiology
- Health Disparities Research
- Health Services Research
Background:
- Racial and sex disparities in catheter ablation (CA) for atrial fibrillation (AF) utilization are known.
- Less is understood about race and sex differences in comorbidity burden and quality of care post-CA.
Purpose of the Study:
- To characterize racial and sex differences in patient and procedural factors influencing prolonged length of stay (LOS) after CA for AF.
- To investigate the impact of race and sex on LOS following CA for AF.
Main Methods:
- Retrospective cohort study of 3345 patients undergoing CA for AF (2018-2024) from a single-center NCDR registry.
- Analysis focused on non-Hispanic White (NHW) and non-Hispanic Black (NHB) patients.
- Multivariable regression and causal mediation analysis assessed associations between race, sex, comorbidities, complications, and prolonged LOS.
Main Results:
- NHB patients were younger, had higher BMI, greater comorbidity burden, and more prolonged LOS and complications compared to NHW patients.
- Female patients were older, had higher rates of paroxysmal AF, transient ischemic attack, and chronic lung disease.
- NHB race (aOR 1.90) and procedural complications (aOR 156) were independently associated with prolonged LOS; sex was not.
- Race-related differences in prolonged LOS were partially mediated by comorbidity burden and obesity, not complications.
Conclusions:
- Prolonged LOS is more common in NHB patients undergoing CA for AF.
- Higher comorbidity burden and obesity, not complications, partially explain the increased LOS in NHB patients.
- Addressing comorbidity management and sociocultural disparities is crucial to reduce prolonged hospitalizations after CA for AF.
Background:
Racial and sex disparities in catheter ablation (CA) utilization for atrial fibrillation (AF) have been documented. Less is known about race and sex differences in comorbidity burden and quality of care outcomes after CA.
Objectives:
We sought to characterize racial and sex differences in patient and procedural characteristics and their impact on prolonged length of stay (LOS) after CA for AF.
Methods:
A retrospective cohort of patients that received CA for AF between 2018 and 2024 was developed from our single center NCDR registry. The analysis was restricted to non-Hispanic White (NHW) and non-Hispanic Black (NHB) patients due to small sample sizes for other groups. The association between race, sex, and prolonged LOS was evaluated using a multivariable stepwise regression model. A sensitivity analysis was performed with the composite outcome of complications given its sparsity. Causal mediation analysis was performed to assess whether race differences in prolonged LOS were mediated by complications.
Results:
Between 2018 and 2024, 3345 patients were included in the cohort. NHB patients were younger and more likely to have Medicaid insurance, higher BMI, higher comorbidity burden, history of atrial flutter, prolonged LOS, and complications after ablation. They were less likely to have prior CA. Female patients were older, less likely to have private insurance and prior CA, and more likely to have paroxysmal AF, transient ischemic attack, and chronic lung disease. NHB race [aOR 1.90 (95% CI: 1.24-2.88), p = 0.003] and a composite outcome of procedural complications [aOR 156 (95% CI: 72.5-377), p < 0.001], but not sex, were independently associated with prolonged LOS. The effect of race on prolonged LOS was partially mediated by higher comorbidity burden and obesity among NHB, but not by complications, Medicaid status, or AF type.
Conclusion:
Prolonged LOS was more frequent among NHB patients undergoing CA. The higher odds of prolonged LOS among NHB patients was not mediated by a higher incidence of complications, suggesting that other factors like comorbidity burden and social determinants of health (SDOH) are more significant contributors. Policies focused on improving comorbidity management and addressing sociocultural disparities may reduce prolonged hospitalizations after CA for AF.
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