Disparities in the access to atrial fibrillation ablation in Denmark

Abstract Background Atrial fibrillation (AF) is a common arrhythmia that can lead to serious complications such as stroke, heart failure, as well as reduced quality of life. Radiofrequency and cryoablation are safe and effective treatments for AF, but they are not offered equally to all patients. Purpose The study aims to identify the demographic groups more or less likely to undergo AF ablation. Methods Using nationwide National Registries, all Danish patients with newly diagnosed AF between the 1st of January 2005, and the 31st of December 2018 were identified. The association between patients, stratified by 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 of AF ablation among these groups was calculated using the Aalen-Johansen estimator, taking death as a competing risk into account. Results A total of 176,248 patients were included in the study. Men were more likely to receive ablation than women (7% vs 3%). When analysing age, 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. Patients with a Ph.D. or doctorate degree were more likely to receive ablation than patients with only basic school education (22% vs 2%). Finally 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 who are not employed or who are retired are less likely to receive AF ablation. These findings suggest that there are significant social and economic disparities in AF ablation treatment in Denmark.Ablation by educationForest plot: Cox analysis