title: Demographic Differences in Catheter Ablation After Hospital Presentation With Symptomatic Atrial Fibrillation.
abstract: BACKGROUND
  Catheter ablation is increasingly used for rhythm control in symptomatic atrial fibrillation (AF), but the demographic characteristics of patients undergoing this procedure are unclear.
  
  
  RESULTS
  We used data on all admissions at nonfederal acute care hospitals in California, Florida, and New York to identify patients discharged with a primary diagnosis of AF between 2006 and 2011. Our primary outcome was readmission for catheter ablation of AF, identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. Cox regression models were used to assess relationships between demographic characteristics and catheter ablation, adjusting for Elixhauser comorbidities. We identified 397 612 eligible patients. Of these, 16 717 (4.20%, 95% CI 0.41 to 0.43) underwent ablation. These patients were significantly younger, more often male, more often white, and more often privately insured, with higher household incomes and lower rates of medical comorbidity. In Cox regression models, the likelihood of ablation was lower in women than men (hazard ratio [HR] 0.83; 95% CI 0.80 to 0.86) despite higher rates of AF-related rehospitalization (HR 1.23; 95% CI 1.21 to 1.24). Compared to whites, the likelihood of ablation was lower in Hispanics (HR 0.60; 95% CI 0.56 to 0.64) and blacks (HR 0.68; 95% CI 0.64 to 0.73), even though blacks had only a slightly lower likelihood of AF-related rehospitalization (HR 0.97; 95% CI 0.94 to 0.99) and a higher likelihood of all-cause hospitalization (HR 1.38; 95% CI 1.37 to 1.39). Essentially the same pattern existed in Hispanics.
  
  
  CONCLUSIONS
  We found differences in use of catheter ablation for symptomatic AF according to sex and race despite adjustment for available data on demographic characteristics and medical comorbidities.
authors.affiliation: Department of Neurology, Neurological Institute of New York, Columbia University College of Physicians and Surgeons, New York, NY (B.R.K.).
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Kummer
authors.affiliation: Division of Cardiology, University of Iowa Carver College of Medicine, Iowa City, IA (P.D.B.).
authors.forename: Prashant D
authors.initials: PD
authors.lastname: Bhave
authors.affiliation: Department of Neurology, Weill Cornell Medical College, New York, NY (A.E.M., H.K.).
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Merkler
authors.affiliation: Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (G.G., H.K.).
authors.forename: Gino
authors.initials: G
authors.lastname: Gialdini
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O.).
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
authors.affiliation: Department of Neurology, Weill Cornell Medical College, New York, NY (A.E.M., H.K.) Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (G.G., H.K.).
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology; D006630:Hispanic or Latino; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People
keywords: ablation; arrhythmia; catheter ablation; sex; women