Sex Disparity in Referral for Catheter Ablation for Atrial Fibrillation at a Single Integrated Health System

Background Catheter ablation for atrial fibrillation (AFCA) is indicated for select patients with atrial fibrillation (AF) and has been shown to reduce AF burden and improve quality of life. Earlier studies demonstrated that women are less likely to undergo AFCA despite having more AF symptoms. We investigated whether an association exists between referral patterns and this sex disparity. Methods and Results A retrospective cohort study was conducted of outpatients with newly diagnosed AF using the electronic medical record at Northwestern. Of 5,445 patients analyzed, 2,108 were women, and 3,337 were men. Characteristics including race, insurance status, comorbidities, and prior AF treatment were compared by sex. Logistic regression models adjusted for socioeconomic and clinical factors were constructed to determine associations between sex and binary dependent variables including referrals to and visits with general cardiology and electrophysiology (EP) and utilization of AFCA. There were no significant differences in odds of referral to (aOR, 1.17 [0.92-1.48], P=0.20) or visits with (aOR, 1.03 [0.82-1.30], P=0.79) general cardiologists between women and men. There were no significant differences in odds of referral to (aOR, 0.83 [0.68-1.01], P=0.06) or visits with (aOR, 0.87 [0.72-1.05], P=0.15) electrophysiologists between women and men. Finally, no significant difference was found in likelihood to undergo AFCA between women and men (aOR, 1.08 [0.83-1.40], P=0.56). Conclusions Our study demonstrates no significant differences in referral patterns to specialists or rates of AFCA between women and men. Encouraging equitable referral to specialists and access to AFCA is essential in ensuring appropriate care for all patients.