Abstract 15698: Association of Social Factors on Sex-Specific Management of Atrial Fibrillation

Abstract

Introduction: Prior studies have reported disparities by sex in managing atrial fibrillation (AF), with many studies having limited analysis of the effects of social risk factors. We examined the effect of social risk factors on sex differences in the management of AF in a large, socially diverse cohort of insured patients. Hypothesis: We hypothesized that women with AF would receive less AF care, including the receipt of AF-related medications, pulmonary vein isolation ablation, and cardiology follow-up, compared to men. Methods: We identified individuals with AF from 2013-2019 captured by Optum’s de-identified Clinformatics® Data Mart Database. Sex was categorized as men and women. Covariates included demographics (age, sex, race, and ethnicity), Elixhauser variables, and social factors such as estimated annual household income and race or ethnicity. We used stepwise multivariable-adjusted Cox proportional hazards models to assess the effect of race, ethnicity, and household annual income on sex-specific differences in the receipt of AF-related medications, pulmonary vein isolation ablation, and cardiology follow-up. Results: We identified 190,760 individuals (age 74.0±11.4 years; 49.9% women) with incident AF. Women with AF were less likely to receive pulmonary vein isolation ablation and cardiology follow-up over a six-year follow-up than men. Prescriptions of antiarrhythmic were identical among both sexes. When stratified by race and ethnicity, women of Black (HR 0.75, 95% CI 0.61,0.92) and White race (HR 0.83, 95% CI 0.78, 0.88) were less likely to receive pulmonary vein isolation ablation than men. Women of Asian (HR 0.90, 95% CI 0.83,0.97) and White race (HR 0.93, 95% CI 0.92,0.94) were less likely to have cardiology follow-up after initial diagnosis of AF than men. Higher household income did not attenuate sex-specific differences in AF care. Across all income categories, women were less likely to have pulmonary vein isolation and cardiology follow-up. Conclusions: We identified sex differences in AF management that were not attenuated when considering race, ethnicity, and annual household income. Our findings suggest continued evidence of sex, racial, ethnic, and socioeconomic inequities in contemporary AF management.