Abstract
Women are less likely to receive guideline-recommended cardiovascular care, but evaluation of sex-based disparities in cardiac surgical procedures is limited. Receipt of concomitant atrial fibrillation (AF) procedures during nonmitral cardiac surgery was compared by sex for patients with preoperative AF. Patients with preoperative AF undergoing coronary artery bypass grafting and/or aortic valve replacement at any of the 33 hospitals in Michigan from 2014 to 2022 were included. Patients with prior cardiac surgery, transcatheter AF procedure, or emergency/salvage status were excluded. Hierarchical logistic regression identified predictors of concomitant AF procedures, account for hospital and surgeon as random effects. Of 5460 patients with preoperative AF undergoing nonmitral cardiac surgery, 24% (n=1291) were women with a mean age of 71years. Women were more likely to have paroxysmal (vs persistent) AF than men (80% vs 72%; P<.001) and had a higher mean predicted risk of mortality (5% vs 3%; P<.001). The unadjusted rate of concomitant AF procedure was 59% for women and 67% for men (P<.001). After risk adjustment, women had 26% lower adjusted odds of concomitant AF procedure than men (adjusted odds ratio, 0.74; 95% CI, 0.64-0.86; P<.001). Female sex was the risk factor associated with the lowest odds of concomitant AF procedure. Women are less likely to receive guideline recommended concomitant AF procedure during nonmitral surgery. Identification of barriers to concomitant AF procedure in women may improve treatment of AF.
Published Version
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