Inequitable Access to Catheter Ablation for Atrial Fibrillation and Adverse Outcomes in a Publicly Funded Healthcare System

Background While all Canadians have universal coverage for hospital-based care, there are limited data describing the determinants of access to catheter ablation for atrial fibrillation (AF) in Canada. Methods This population-based cohort study from Alberta, Canada (2013-2020) included adults (≥18 years) with new onset AF in whom a rhythm control strategy was desired. Factors associated with ablation within 5 years were identified using multivariable logistic regression models. The association between ablation and outcomes was assessed in a propensity score matched cohort using Cox proportional hazard models, where the time to ablation was treated as a time-varying covariate to mitigate immortal time bias. Results Of 11,844 patients, 8.7% (n=1,014) received ablation within 5 years of diagnosis. The mean cohort age was 64.6±14.0 years, 35.1% were female, and the mean CHA 2 DS 2 -VASc score was 2.6±1.9. Patients were less likely to receive ablation if they were older, female, or had hypertension, heart failure or kidney disease. Ablation was more common in patient with higher socioeconomic status. In the propensity score matched cohort, ablation was associated with a lower risk of AF recurrence (HR 0.59; 95% 0.48-0.72; P