2 For patients with symptomatic paroxysmal AF, a rhythm control strategy has been shown to improve quality of life. 1 Although a rate control strategy is a reasonable approach for managing AF in many patients, certain factors clearly favor a rhythm control strategy. These findings highlight inequities in paroxysmal AF management based on race/ethnicity and socioeconomic status.Ītrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with substantial morbidity and mortality, including frequent hospitalizations, heart failure, and thromboembolic events. Latinx ethnicity (aOR, 0.73 95% CI, 0.60-0.89 P = .002) and lower zip code–linked median household income (aOR for <$50 000: 0.61 aOR for $50 000-$99 999: 0.81 compared with ≥$100 000) were independently associated with lower catheter ablation use among those receiving rhythm control.Ĭonclusions and Relevance This study found that despite increased use of rhythm control strategies for treatment of paroxysmal AF, catheter ablation use remained low and patients from racial/ethnic minority groups and those with lower income were less likely to receive rhythm control treatment, especially catheter ablation. 001) and lower zip code–linked median household income (aOR for <$50 000: 0.83 aOR for $50 000-$99 999: 0.92 compared with ≥$100 000) were independently associated with lower use of rhythm control. In multivariable analyses, Black race (adjusted odds ratio, 0.89 95% CI, 0.83-0.94 P <. Between 20, the cumulative percentage of patients treated with catheter ablation increased from 1.6% to 3.8%. A total of 86 359 patients (79.1%) were treated with rate control, 19 362 patients (17.7%) with AADs, and 3500 (3.2%) with catheter ablation. Results Of the 109 221 patients who met the inclusion criteria, 55 185 were men (50.5%) and 73 523 were White (67.3%), with a median (interquartile range) age of 75 (68-82) years. Multivariable logistic regression models were used to assess the association of race/ethnicity and zip code–linked median household income with a rhythm control strategy (AADs or catheter ablation) vs a rate control strategy as well as with catheter ablation vs AADs among those receiving rhythm control. Main Outcomes and Measures Treatment with a rhythm control strategy, and catheter ablation specifically, among those who received rhythm control. Patients were excluded if they did not have continuous insurance enrollment for at least 1 year before and at least 6 months after study entry.Įxposures Race/ethnicity and zip code–linked median household income. Adult patients (aged ≥18 years) in the database with a diagnosis of incident paroxysmal AF were identified. Objective To ascertain the cumulative rates of AAD and catheter ablation use for the management of paroxysmal AF and to investigate for the presence of inequities in AF management by evaluating the association of race/ethnicity and socioeconomic status with their use in the United States.ĭesign, Setting, and Participants This cohort study obtained inpatient, outpatient, and pharmacy claims data from the Optum Clinformatics Data Mart between October 1, 2015, and June 30, 2019. Adoption of advanced cardiovascular therapeutics, however, is often slower among patients from racial/ethnic minority groups and those with lower income. Importance In patients with paroxysmal atrial fibrillation (AF), rhythm control with either antiarrhythmic drugs (AADs) or catheter ablation has been associated with decreased symptoms, prevention of adverse remodeling, and improved cardiovascular outcomes. ![]() Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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