Gender and Socioeconomic Bias in the Management and Mortality of Patients with Atrial Fibrillation

Atrial fibrillation (AF) is one of the most common arrhythmias in the general population and similar to other cardiovascular diseases, studies have shown that outcomes and treatment choices are often affected by gender and socioeconomic disparities.

This study aimed to investigate the differences in AF management and all-cause mortality based on gender and socioeconomic status.

This cross-sectional analysis used a large, de-identified electronic health record (EHR)-based database, Explorys. covering over 60 million patient records between January 1, 2010 and October 31, 2019. We identified 1.7 million patients with AF using International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Patients were stratified based on age, gender, insurance provider and type of AF therapy (medical vs. catheter ablation). The main outcomes were all-cause mortality and the type of treatment patient received.

Of the 1.7 million patients with AF we identified, 712,700 underwent catheter ablation. Females were significantly less likely to undergo catheter ablation compared with males for both paroxysmal AF (3.28% vs. 4.65%) and permanent AF (15.63% vs. 47.75%). Patients with Medicaid insurance were the least likely to receive catheter ablation (3.3%) compared with those with Medicare (46.5%) and private insurance (50.2%). Female patients had higher all-cause mortality as compared with male patients (10.64% vs. 7.82% for males; p < 0.0001) with the highest rate for female patients on Medicaid (Adjusted OR = 1.5; 95% CI: 1.4-1.6). In multivariable logistic regression adjusting for age group, AF subtype, and insurance category, female sex and Medicaid insurance remained independently associated with lower odds of receiving catheter ablation.

In this large EHR-based analysis of patients with AF, female gender and Medicaid insurance were associated with lower use of catheter ablation and higher all-cause mortality. These findings highlight the need to better understand and address gender- and socioeconomic-based inequities in AF care and outcomes.