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Equity of Access and Outcomes: A Comparison Between In-Area and Out-of-Area Patients Undergoing Ventricular
Ashish Sood1, Samual Turnbull1, Kasun De Silva1
1Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, The University of Sydney, Sydney, NSW, Australia.
Background:
Improved patient outcomes after ventricular arrhythmia (VA) ablation procedure have been found to correlate with procedures being performed in high volume centres. Whether the concentration of expertise in experienced, urban centres disadvantages out-of-area (OOA) patients requires investigation.
Methods:
We retrospectively analysed 280 patients undergoing catheter ablation for VAs between 2017 and 2021 at an expert referral centre for VA ablation. In-area (IA) and OOA cases were compared for differences in time from referral to electrophysiologist consultation and ablation procedure. For the subset of patients undergoing catheter ablation for non-premature ventricular complex (PVC) ablation, differences in rates of ventricular tachycardia (VT) recurrence and a composite outcome of VT recurrence, cardiac transplantation or death were also compared.
Results:
One hundred and eighteen (42.1%) cases during the study period were OOA referrals. The median time from referral to consultation was 0 days (interquartile range [IQR] 0-12), and from referral to ablation was 10 days (IQR 3-87); with no significant difference between IA and OOA patients with regards to timing of ablation (p=0.86 and p=0.32 respectively). IA and OOA patients undergoing non-PVC ablations had similar rates of VT recurrence (34.7% vs. 35.7%, p=0.89) and the composite endpoint (48.3% vs. 44.0%, p=0.55).
Conclusion:
For patients referred to undergo VA ablation at our urban tertiary centre, OOA patients are not disadvantaged compared to IA patients in terms of time to consultation and/or ablation, or long-term outcomes.
