Gender, Race, and Health Insurance Status in Patients Undergoing Catheter Ablation for Atrial Fibrillation

被引:90
作者
Patel, Nileshkumar [1 ]
Deshmukh, Abhishek [2 ]
Thakkar, Badal [3 ]
Coffey, James O. [1 ]
Agnihotri, Kanishk [4 ]
Patel, Achint [5 ]
Ainani, Nitesh [6 ]
Nalluri, Nikhil [7 ]
Patel, Nilay [4 ]
Patel, Nish [1 ]
Patel, Neil [5 ]
Badheka, Apurva O. [8 ]
Kowalski, Marcin [7 ]
Hendel, Robert [1 ]
Viles-Gonzalez, Juan [1 ]
Noseworthy, Peter A. [2 ]
Asirvatham, Samuel [2 ]
Lo, Kaming [1 ]
Myerburg, Robert J. [1 ]
Mitrani, Raul D. [1 ]
机构
[1] Univ Miami, Miller Sch Med, Miami, FL 33136 USA
[2] Mayo Clin, Rochester, MN USA
[3] Tulane Sch Publ Hlth & Trop Med, New Orleans, LA USA
[4] St Peters Univ Hosp, New Brunswick, NJ USA
[5] Icahn Sch Med Mt Sinai, New York, NY 10029 USA
[6] Tufts Univ, Sch Med, Baystate Med Ctr, Springfield, MA 01199 USA
[7] Staten Isl Univ Hosp, Staten Isl, NY USA
[8] Yale Univ, Sch Med, New Haven, CT USA
关键词
UNITED-STATES; RADIOFREQUENCY ABLATION; ANTIARRHYTHMIC-DRUGS; PREVENTION; CARE; SEX; DISPARITIES; TRENDS; RISK; PROGRESS;
D O I
10.1016/j.amjcard.2016.01.040
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Catheter ablation for atrial fibrillation (AF) has emerged as a popular procedure. The purpose of this study was to examine whether there exist differences or disparities in ablation utilization across gender, socioeconomic class, insurance, or race. Using the Nationwide Inpatient Sample (2000 to 2012), we identified adults hospitalized with a principal diagnosis of AF by ICD 9 code 427.31 who had catheter ablation (ICD 9 code-37.34). We stratified patients by race, insurance status, age, gender, and hospital characteristics. A hierarchical multivariate mixed-effect model was created to identify the independent predictors of AF ablation. Among an estimated total of 3,508,122 patients (extrapolated from 20% Nationwide Inpatient Sample) hospitalized with a diagnosis of AF in the United States from the year 2000 to 2012, 102,469 patients (2.9%) underwent catheter ablations. The number of ablations was increased by 940%, from 1,439 in 2000 to 15,090 in 2012. There were significant differences according to gender, race, and health insurance status, which persisted even after adjustment for other risk factors. Female gender (0.83 [95% CI 0.79 to 0.87; p <0.001]), black (0.49 [95% CI 0.44 to 0.55; p <0.001]), and Hispanic race (0.64 [95% CI 0.56 to 0.72; p <0.001]) were associated with lower likelihoods of undergoing an AF ablation. Medicare (0.93, 0.88 to 0.98, <0.001) or Medicaid (0.67, 0.59 to 0.76, <0.001) coverage and uninsured patients (0.55, 0.49 to 0.62, <0.001) also had lower rates of AF ablation compared to patients with private insurance. In conclusion we found differences in utilization of catheter ablation for AF based on gender, race, and insurance status that persisted over time. (C) 2016 Elsevier Inc. All rights reserved.
引用
收藏
页码:1117 / 1126
页数:10
相关论文
共 28 条
[1]  
[Anonymous], BIOMETRICS
[2]   Percutaneous Aortic Balloon Valvotomy in the United States: A 13-Year Perspective [J].
Badheka, Apurva O. ;
Patel, Nileshkumar J. ;
Singh, Vikas ;
Shah, Neeraj ;
Chothani, Ankit ;
Mehta, Kathan ;
Deshmukh, Abhishek ;
Ghatak, Abhijit ;
Rathod, Ankit ;
Desai, Harit ;
Savani, Ghanshyambhai T. ;
Grover, Peeyush ;
Patel, Nilay ;
Arora, Shilpkumar ;
Grines, Cindy L. ;
Schreiber, Theodore ;
Makkar, Raj ;
Rihal, Charanjit S. ;
Cohen, Mauricio G. ;
De Marchena, Eduardo ;
O'Neill, William W. .
AMERICAN JOURNAL OF MEDICINE, 2014, 127 (08) :744-+
[3]   Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation [J].
Bhave, Prashant D. ;
Lu, Xin ;
Girotra, Saket ;
Kamel, Hooman ;
Sarrazin, Mary S. Vaughan .
HEART RHYTHM, 2015, 12 (07) :1406-1412
[4]   Treatment of Atrial Fibrillation With Antiarrhythmic Drugs or Radiofrequency Ablation Two Systematic Literature Reviews and Meta-Analyses [J].
Calkins, Hugh ;
Reynolds, Matthew R. ;
Spector, Peter ;
Sondhi, Manu ;
Xu, Yingxin ;
Martin, Amber ;
Williams, Catherine J. ;
Sledge, Isabella .
CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 2009, 2 (04) :349-U49
[5]   Sex differences in the use of implantable cardioverter-defibrillators for primary and secondary prevention of sudden cardiac death [J].
Curtis, Lesley H. ;
Al-Khatib, Sana M. ;
Shea, Alisa M. ;
Hammill, Bradley G. ;
Hernandez, Adrian F. ;
Schulman, Kevin A. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2007, 298 (13) :1517-1524
[6]   In-Hospital Complications Associated With Catheter Ablation of Atrial Fibrillation in the United States Between 2000 and 2010 Analysis of 93 801 Procedures [J].
Deshmukh, Abhishek ;
Patel, Nileshkumar J. ;
Pant, Sadip ;
Shah, Neeraj ;
Chothani, Ankit ;
Mehta, Kathan ;
Grover, Peeyush ;
Singh, Vikas ;
Vallurupalli, Srikanth ;
Savani, Ghanshyambhai T. ;
Badheka, Apurva ;
Tuliani, Tushar ;
Dabhadkar, Kaustubh ;
Dibu, George ;
Reddy, Y. Madhu ;
Sewani, Asif ;
Kowalski, Marcin ;
Mitrani, Raul ;
Paydak, Hakan ;
Viles-Gonzalez, Juan F. .
CIRCULATION, 2013, 128 (19) :2104-2112
[7]   ADAPTING A CLINICAL COMORBIDITY INDEX FOR USE WITH ICD-9-CM ADMINISTRATIVE DATABASES [J].
DEYO, RA ;
CHERKIN, DC ;
CIOL, MA .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 1992, 45 (06) :613-619
[8]   Coronary Revascularization Trends in the United States, 2001-2008 [J].
Epstein, Andrew J. ;
Polsky, Daniel ;
Yang, Feifei ;
Yang, Lin ;
Groeneveld, Peter W. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2011, 305 (17) :1769-1776
[9]   Characteristics of patients undergoing atrial fibrillation ablation: Trends over a seven-year period 1999-2005 [J].
Gerstenfeld, Edward P. ;
Callans, David ;
Dixit, Sanjay ;
Lin, David ;
Cooper, Joshua ;
Russo, Andrea M. ;
Verdino, Ralph ;
Weiner, Mark ;
Zado, Erica ;
Marchlinski, Francis E. .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2007, 18 (01) :23-28
[10]   Prevalence of diagnosed atrial fibrillation in adults - National implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study [J].
Go, AS ;
Hylek, EM ;
Phillips, KA ;
Chang, YC ;
Henault, LE ;
Selby, JV ;
Singer, DE .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 285 (18) :2370-2375