PO-01-196 MINORITIES HAVE GREATER LONG-TERM ATRIAL FIBRILLATION-FREE SURVIVAL POST ABLATION DESPITE LOWER REFERRAL RATES AND HIGHER INCIDENCE OF BASELINE COMORBIDITIES

Abstract

Significant differences in the incidence and management of atrial fibrillation (AF) have been observed based on patient sex and race. Women with AF tend to be older, have higher stroke/mortality risk, and receive catheter ablation less often than men, while racial minority patients paradoxically have lower prevalence of AF than nonminority patients despite a higher burden of traditional risk factors. To explore the sex and racial profile of patients undergoing catheter ablation for AF and their ablation outcomes. We conducted a retrospective cross-sectional analysis of all de novo AF catheter ablations performed from Jan 6, 2015 to Oct 28, 2021 using the common electronic health record across a large healthcare system. Inclusion criteria included a self-identification race and having at least one follow-up visit after the blanking period. Patients who self-identified as Caucasian American/White race were defined as Nonminority while patients who self-identified as Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander and multiracial were defined as Racial minority. A survival analysis of the first documented recurrence of any atrial tachyarrhythmia was also performed. A total of 1,634 subjects with a median age of 68 (IQR=61-75) years were analyzed. Patients were predominantly male (65.9%) and nonminority (79.6%) with mostly paroxysmal AF (60.9%). Among minority patients, 35.9% were identified as Black/African Americans, 18.3% as Asians, and 44.0% as multiracial. Minority patients were more likely to be younger (p<0.001) and have diabetes mellitus (p<0.001), heart failure (p<0.001), chronic kidney disease (p<0.001), prior stroke/transient ischemia attack (p=0.012) and hypertension (p<0.001) while less likely to have obstructive sleep apnea (p=0.01), cancer (p=0.036) and persistent AF (p=0.05). Minority patients had lower odds of AF recurrences (hazard ration (HR) = 0.73, 95% CI 0.58 – 0.95; Figure 1a) which remained significant after adjusting for baseline differences (adjusted HR = 0.70, 95% CI 0.55 – 0.91, p<0.001) while sex had no effect on AF recurrences (Figure 1). Referral for catheter ablation for AF favored nonminority and male patients. Despite higher incidence of comorbidities and lower referral rates, minority patients had lower adjusted odds of AF recurrences. Further exploration is warranted to understand the factors underlying these utilization and outcomes disparities.