Sex disparity in referral for catheter ablation for atrial fibrillation

Background: Catheter ablation for atrial fibrillation (AFCA) 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: A retrospective cohort study was conducted of outpatients with newly diagnosed AF at a single tertiary referral center. 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 AFCA utilization. Results: Of 6850 patients analyzed, 2693 were women, and 4157 were men. No significant differences were found in odds of referral to (aOR, 1.13 [0.92–1.40], P = 0.25) or visits with (aOR, 1.05 [0.86–1.29], P = 0.62) general cardiologists between women and men. Women were found to be less likely to visit with EP than men (aOR, 0.88 [0.79–0.99], P = 0.03). In analyses of referral patterns after release of the 2014 AHA/ACC/HRS guidelines, women were found to be referred to (aOR, 0.78 [0.63–0.95], P = 0.01) and visit with (aOR, 0.86 [0.75–0.99], P = 0.03) EP less frequently than men. Finally, no significant difference was found in likelihood to undergo AFCA between women and men (aOR, 1.05 [0.83–1.33], P = 0.67). Conclusions: This study uncovered significant differences in rates of referral to and visits with EP between women and men. Encouraging equitable referral to specialists and access to AFCA is essential in ensuring appropriate care for all patients.