Racial/Ethnic and Socioeconomic Disparities in Management of Incident Paroxysmal Atrial Fibrillation.
Racial/Ethnic and Socioeconomic Disparities in Management of Incident Paroxysmal Atrial Fibrillation.
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DOI：
10.1001/jamanetworkopen.2021.0247
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发表时间：
2021-02-01
影响因子：
13.8
通讯作者：
Frankel DS
中科院分区：
文献类型：
--
作者：
Eberly LA;Garg L;Yang L;Markman TM;Nathan AS;Eneanya ND;Dixit S;Marchlinski FE;Groeneveld PW;Frankel DS
本队列研究检查了住院、门诊和药房索赔，以确定商业保险的阵发性房颤成人患者使用抗心律失常药物和导管消融术的情况。在美国阵发性房颤（AF）患者中，种族/民族和社会经济地位是否与心律控制策略（抗心律失常药物和导管消融），特别是导管消融的使用相关？在这项对109221例阵发性房颤患者的队列研究中，黑人种族和与邮政编码相关的较低家庭收入中位数与较少使用心律控制策略相关，拉丁裔种族和与邮政编码相关的较低家庭收入中位数与较少使用导管消融相关。本研究的结果表明，在美国阵发性房颤的管理中可能存在种族/民族和社会经济不平等。在阵发性房颤（AF）患者中，使用抗心律失常药物（AAD）或导管消融进行心律控制与症状减轻、预防不良重构和改善心血管结局相关。然而，采用先进的心血管治疗，往往是缓慢的种族/少数民族群体和那些较低收入的患者。确定AAD和导管消融用于治疗阵发性房颤的累积使用率，并通过评价人种/种族和社会经济地位与其在美国使用的相关性来调查房颤治疗中是否存在不公平现象。这项队列研究从Optum Clinformatics Data Mart获得了2015年10月1日至2019年6月30日期间的住院、门诊和药房索赔数据。确定了数据库中诊断为阵发性AF的成人患者（年龄≥ 18岁）。如果患者在入组研究前至少1年和入组研究后至少6个月没有连续入组保险，则将其排除。种族/民族和邮政编码相关的家庭收入中位数。在接受节律控制的患者中，采用节律控制策略进行治疗，特别是导管消融。使用多变量逻辑回归模型评估种族/民族和邮政编码相关的家庭收入中位数与节律控制策略（AAD或导管消融）vs心率控制策略以及接受节律控制的患者中导管消融vs AAD的相关性。在符合入选标准的109221例患者中，55185例为男性（50.5%），73523例为白色（67.3%），中位（四分位距）年龄为75（68 - 82）岁。共有86359例患者（79.1%）接受了心率控制治疗，19362例患者（17.7%）接受了AAD治疗，3500例患者（3.2%）接受了导管消融治疗。2016年至2019年期间，接受导管消融治疗的患者的累积百分比从1.6%增加到3.8%。在多变量分析中，黑人（调整后的比值比[aOR]，0.89; 95%CI，0.83 - 0.94; P <0.001）和邮政编码相关的家庭收入中位数较低与≥ 100 000美元相比，<50 000美元的aOR为0.83 [95% CI，0.79 - 0.87; P <.001]; 50 000 - 99 999美元的aOR为0.92 [95% CI，0.88 - 0.96; P =<.001]与心律控制使用率较低独立相关。拉丁裔（aOR，0.73; 95% CI，0.60 - 0.89; P = 0.002）和较低的邮政编码相关的家庭收入中位数（<50 000美元的aOR：0.61 [95%CI，0.54 - 0.69; P <.001]; 50 000美元-99 999美元的aOR：0.81 [95%CI，0.72 - 0.90; P <.001]与≥ 100 000美元相比）与接受心律控制的患者中导管消融使用率较低独立相关。该研究发现，尽管阵发性房颤治疗中使用节律控制策略的情况有所增加，但导管消融术的使用率仍然较低，少数种族/族裔群体和低收入人群的患者接受节律控制治疗的可能性较小，尤其是导管消融术。这些发现强调了基于种族/民族和社会经济地位的阵发性房颤管理的不公平性。
This cohort study examines inpatient, outpatient, and pharmacy claims to identify use of antiarrhythmic drugs and catheter ablation among commercially insured adults with paroxysmal atrial fibrillation. Are race/ethnicity and socioeconomic status associated with use of a rhythm control strategy (antiarrhythmic drugs and catheter ablation), and specifically catheter ablation, among patients with paroxysmal atrial fibrillation (AF) in the United States? In this cohort study of 109 221 patients with incident paroxysmal AF, Black race and lower zip code–linked median household income were associated with less use of a rhythm control strategy, and Latinx ethnicity and lower zip code–linked median household income were associated with less use of catheter ablation. Results of this study suggest that racial/ethnic and socioeconomic inequities may be present in management of paroxysmal AF in the United States. In patients with paroxysmal atrial fibrillation (AF), rhythm control with either antiarrhythmic drugs (AADs) or catheter ablation has been associated with decreased symptoms, prevention of adverse remodeling, and improved cardiovascular outcomes. Adoption of advanced cardiovascular therapeutics, however, is often slower among patients from racial/ethnic minority groups and those with lower income. To ascertain the cumulative rates of AAD and catheter ablation use for the management of paroxysmal AF and to investigate for the presence of inequities in AF management by evaluating the association of race/ethnicity and socioeconomic status with their use in the United States. This cohort study obtained inpatient, outpatient, and pharmacy claims data from the Optum Clinformatics Data Mart between October 1, 2015, and June 30, 2019. Adult patients (aged ≥18 years) in the database with a diagnosis of incident paroxysmal AF were identified. Patients were excluded if they did not have continuous insurance enrollment for at least 1 year before and at least 6 months after study entry. Race/ethnicity and zip code–linked median household income. Treatment with a rhythm control strategy, and catheter ablation specifically, among those who received rhythm control. Multivariable logistic regression models were used to assess the association of race/ethnicity and zip code–linked median household income with a rhythm control strategy (AADs or catheter ablation) vs a rate control strategy as well as with catheter ablation vs AADs among those receiving rhythm control. Of the 109 221 patients who met the inclusion criteria, 55 185 were men (50.5%) and 73 523 were White (67.3%), with a median (interquartile range) age of 75 (68-82) years. A total of 86 359 patients (79.1%) were treated with rate control, 19 362 patients (17.7%) with AADs, and 3500 (3.2%) with catheter ablation. Between 2016 and 2019, the cumulative percentage of patients treated with catheter ablation increased from 1.6% to 3.8%. In multivariable analyses, Black race (adjusted odds ratio [aOR], 0.89; 95% CI, 0.83-0.94; P < .001) and lower zip code–linked median household income (aOR for <$50 000: 0.83 [95% CI, 0.79-0.87; P < .001]; aOR for $50 000-$99 999: 0.92 [95% CI, 0.88-0.96; P = <.001] compared with ≥$100 000) were independently associated with lower use of rhythm control. Latinx ethnicity (aOR, 0.73; 95% CI, 0.60-0.89; P = .002) and lower zip code–linked median household income (aOR for <$50 000: 0.61 [95% CI, 0.54-0.69; P < .001]; aOR for $50 000-$99 999: 0.81 [95% CI, 0.72-0.90; P < .001] compared with ≥$100 000) were independently associated with lower catheter ablation use among those receiving rhythm control. This study found that despite increased use of rhythm control strategies for treatment of paroxysmal AF, catheter ablation use remained low and patients from racial/ethnic minority groups and those with lower income were less likely to receive rhythm control treatment, especially catheter ablation. These findings highlight inequities in paroxysmal AF management based on race/ethnicity and socioeconomic status.
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影响因子：
5.5
作者：
Bhave PD;Lu X;Girotra S;Kamel H;Vaughan Sarrazin MS
通讯作者：
Vaughan Sarrazin MS
DOI：
10.1161/circoutcomes.119.005600
发表时间：
2019-04
影响因子：
6.9
作者：
Nathan, Ashwin S.;Geng, Zhi;Dayoub, Elias J.;Khatana, Sameed Ahmed M.;Eberly, Lauren A.;Kobayashi, Taisei;Pugliese, Steven C.;Adusumalli, Srinath;Giri, Jay;Groeneveld, Peter W.
通讯作者：
Groeneveld, Peter W.
影响因子：
1.4
作者：
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通讯作者：
Paasche-Orlow, Michael K.
影响因子：
2
作者：
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通讯作者：
Himmelfarb, Cheryl R. Dennison
影响因子：
9.7
作者：
Eberly, Lauren A.;Richterman, Aaron;Zon, Rebecca
通讯作者：
Zon, Rebecca