225 - EVIDENCE OF INEQUITABLE ACCESS TO CATHETER ABLATION FOR ATRIAL FIBRILLATION WITHIN THE CANADIAN UNIVERSAL HEALTH CARE SYSTEM

Background: Timely access to catheter ablation (CA) may be a challenge for many health care systems. While all Canadians have universal coverage for hospital services including CA, there are limited data describing predictors of access to CA and an improved understanding of these factors may help identify strategies to address care gaps. The study objectives were: (a) to identify the predictors of CA among patients with new onset AF and intended rhythm control, and (b) to assess cardiovascular outcomes associated with early CA within 1 year.

METHODS AND RESULTS: Using linked administrative data from Alberta, Canada (2008-2020), adults (≥18 years) with AF and prescription for an anti-arrhythmic drugs (i.e., class I or III) were included. Predictors of CA within 5 years of initiation of antiarrhythmic drugs were identified using multivariable logistic regression models. Cox proportional hazard models were used to compare 5-year cardiovascular outcomes (i.e., AF recurrent, hospitalization and mortality) in a propensity score matched CA (within 1 year of index) cohort and no CA cohort. Landmark analysis at 15 months was chosen to mitigate immortal time bias and account for the post-ablation blanking period.

Of 18,091 patients who met inclusion criteria, 6.3% (n=1,143) received CA within 5 years. The mean age was 64.6±14.0 years, 34.6% were female, and the mean CHADS2VAsC score was 2.6±1.9. In the multivariable models (Table), patients were less likely to receive CA if they were older, female, had hypertension or diabetes. CA ablation was more likely in the highest quintiles of neighborhood socioeconomic status. In the propensity score matched cohort, CA was associated with a lower risk of AF recurrence (HR 0.48; 95% 0.31 – 0.76) (Figure), heart failure hospitalization (HR 0.40; 95% CI 0.17 – 0.92), and all-cause mortality (HR 0.40; 95% CI 0.18 – 0.87).


Conclusion: While a decreased likelihood of CA may be anticipated with older age and additional comorbidity, there are also observed disparities in CA rates based on sex and socioeconomic status. Our analysis is concordant with the literature that early CA is associated with low AF recurrence and improved survival. These results highlight current gaps in access and inform health services planning and advocacy for more equitable patient access to CA.