The largest-of-its-kind study proves race and gender-related disparities exist in care for patients who have recently been diagnosed with atrial fibrillation (AF). The study, published in the July edition of HeartRhythm, the official journal of the Heart Rhythm Society (HRS), includes data from more than 500,000 Medicare beneficiaries and notably finds that female patients compared to male patients are less likely to receive oral anticoagulation, a medication used to lower the likelihood of experiencing a stroke. Women are also less likely than men to receive an ablation, as were Hispanics versus whites.
AF is the most common heart arrhythmia and increases the risk of stroke fivefold. AF is a highly prevalent problem in the United States (U.S.), affecting about five percent of the population aged 65 years and older[i]. As the world population ages, the prevalence of AF is projected to increase. In fact, in the next 30-40 years, the number of people diagnosed with AF in the U.S. is expected to more than double. For patients with AF, therapies are available to manage symptoms and treat AF, such as use of anticoagulation (or blood thinners), rate- and rhythm-controlling medications, cardioversion, or ablation.
The study found statistically significant differences in the use of AF-related services by both race and gender, with white patients and male patients receiving the most care. Specifically, women were less likely than men to receive anticoagulation (35.0 vs. 38.8 percent), and both blacks and Hispanics were less likely than whites (30.5 vs. 31.4 vs. 37.3 percent). Women were also less likely than men to receive an ablation (0.6 vs. 1.3 percent), as were Hispanics versus whites (0.6 vs. 0.9 percent). Hispanics and women were less likely to have an outpatient clinic visit with an electrophysiologist (EP) compared to their counterparts. Other differences were also seen in rate- and rhythm-controlling medications.
More than 500,000 (517,941) Medicare patients newly diagnosed with AF were compared using collective data from the Centers for Medicare and Medicaid (CMS) during 2010-2011. The usage of medical services within 90 days of initial AF diagnosis was cataloged to determine any racial or gender differences. The services analyzed included: visit to a cardiologist, visit to an EP, and use of anticoagulation, rate-controlling medications, rhythm-controlling medications, or radiofrequency ablation.
"While we have seen racial and gender differences in the care of other cardiac conditions, our study is the first to broadly look at and show disparities in the receipt of care specifically for AF. Particularly, it was of concern to see that women were less likely to receive oral anticoagulation since they are at greater risk of stroke compared to men," said Prashant Bhave, MD, FHRS, Clinical Assistant Professor in the Department of Internal Medicine for University of Iowa Health Care. "It is essential that each patient is treated with a consistent standard of care, regardless of race or gender. Increasing awareness about AF and effective therapy options is one step we need to take to help narrow this health equity gap."
The study authors note that identifying patterns of disparity and barriers to care at the regional and local level may help to guide community-based interventions. Strategies to educate patients, change patterns of referral, and improve access to specialty care for women and minorities with AF may help to improve the quality of life and outcomes in those patients.