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. 2024 Aug 30;26(9):euae231.
doi: 10.1093/europace/euae231.

Disparities in the access to atrial fibrillation ablation in Denmark: who gets ablated, who neglected?

Christopher R Zörner  1 , Jacob Tønnesen  1 , Lise Da Riis-Vestergaard  1 , Charlotte Middelfart  1 , Regitze Hein  1 , Peter Vibe Rasmussen  1 , Martin H Ruwald  1 , Gunnar Gislason  1   2   3   4 , Morten Lock Hansen  1   3
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Disparities in the access to atrial fibrillation ablation in Denmark: who gets ablated, who neglected?

Christopher R Zörner et al. Europace. .

Abstract

Aims: Atrial fibrillation (AF) is a common arrhythmia associated with reduced quality of life that can lead to serious complications such as stroke and heart failure. Ablation is a safe and effective treatment for AF but is not offered equally to all patients. The aim of this study is to identify demographic groups more or less likely to undergo AF ablation.

Methods and results: All patients with newly diagnosed AF between 2010 and 2018 were identified in the Danish nationwide registries. The association between gender, age, level of education and attachment to the job market, and the likelihood of receiving AF ablation was investigated using multivariable Cox proportional hazard analysis. Cumulative incidence was calculated using the Aalen-Johansen estimator. A total of 176 248 patients were included. Men were more likely to receive ablation than women (7% vs. 3%). Patients aged 25-44 and 45-64 were most likely to receive ablation, while only 0.7% of patients aged 80 or above received ablation. The rate of ablation significantly decreased with decreasing level of education. Full-time employed patients were most likely to receive ablation, followed by self-employed, unemployed, on sick leave, undergoing education, and early retired patients. Retired patients were the least likely to receive ablation (3%).

Conclusion: This study found that women, older patients, patients with lower levels of education, and patients on social benefits are less likely to receive AF ablation. These findings suggest that there are significant social and economic disparities in AF ablation treatment in Denmark.

Keywords: Ablation; Atrial fibrillation; Denmark; Disparity; Healthcare access.

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Conflict of interest statement

Conflict of interest: none declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Cumulative incidence of AF ablation: divided by gender. AF, atrial fibrillation.
Figure 2
Figure 2
Forest plot with HR for AF ablation. AF, atrial fibrillation; CI, confidence interval; HR, hazard ratio.
Figure 3
Figure 3
Cumulative incidence of AF ablation: divided by age group. AF, atrial fibrillation.
Figure 4
Figure 4
Cumulative incidence of AF ablation: divided by level of education. AF, atrial fibrillation.
Figure 5
Figure 5
Cumulative incidence of AF ablation: divided by employment status. AF, atrial fibrillation.
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