Abstract 15068: Regional Variation in Atrial Fibrillation Ablation Care for Medicare Beneficiaries Across the United States

Abstract

Background: Despite recognition of the role of early ablation for favorable long-term outcomes in atrial fibrillation (AF), access to these services requires substantial resources and expertise. We investigated county-level variation in the availability of AF ablation care for the Medicare population. Methods: In Medicare physician claims from 2019 linked to AHRQ county characteristics, we evaluated the volume of AF ablation per 100,000 population over the age of 65 years across US counties. We examined county characteristics associated with local access to ablation care, evaluating county-level differences in population composition, cardiovascular risk factor burden, and access to primary care (number per 100,000 population). Results: A total of 64,055 beneficiaries received AF ablation care from 1,501 physicians across the US. Of 3,143 U.S. counties, 403 (12.8%) in 2019 had any ablation procedures. In counties with local ablation care, a median 182 beneficiaries per 100,000 persons ≥65 years of age underwent AF ablation, with a wide variation in volumes across counties - interquartile range 97 per 100,000 to 337 per 100,000 ( Figure). Of the total estimated 49,238,690 persons ≥65 years of age across counties within the United States and District of Columbia, 18,639,381 (37.9%) resided in counties without AF ablation services in the same county. In adjusted analyses, counties without local AF ablation services did not differ in demographic characteristics or prevalence of cardiovascular risk factors but were characterized by lower access to primary care physicians and lower educational attainment among county residents (P<0.01 for both). Conclusions: Only 1 in 8 US counties has local AF ablation care, with over one-third of U.S. adults ≥65 years of age residing in counties without local services. Patient-centered care necessitates greater accessibility for many patients without proximity to AF ablation care, especially with expanding indications.