Abstract 4147416: Racial Disparities in Periprocedural Outcomes and Mortality in Catheter Ablation of Atrial Fibrillation Among Congestive Heart Failure Patients in the United States: An Analysis from the National Inpatient Sample Database

Background: Atrial Fibrillation (AF) and congestive heart failure (CHF) are intertwined disorders that contribute to cardiovascular morbidity and mortality. Arrhythmia burden is a key prognostic factor in patients with AF and CHF. Numerous studies have suggested that catheter ablation outperforms conventional therapies in improving clinical outcomes for these patients. This study aims to evaluate the racial disparities affecting periprocedural outcomes and mortality in CHF patients undergoing AF ablation. Methods: We searched the National Inpatient Sample (NIS) data from 2016 to 2021 using ICD-10 and ICD-10-PCS9 codes to look for patients with CHF who underwent ablation for AF and stratified the data on the basis of race, particularly African American(AA) and White American (WA) population. We used the Pearson Chi-Square test to analyze categorical variables and the Wilcoxon Rank Sum test for continuous variables to evaluate racial disparities in the periprocedural outcomes in patients undergoing ablation. Additionally, we also used a multivariate logistic regression analysis to compute adjusted odds ratios (aORs) for outcomes. Results: After analyzing NIS data from 2016 to 2021, among 7,803,487 patients admitted for AF and CHF, only 94,245 underwent ablation. Among those who underwent ablation, AA were admitted and received ablation at a younger age compared to WA (63.89 years versus 71.48 years). We found that AA patients experienced higher rates of HF exacerbation (91% vs 88.9%, p:0.006, ), cardiogenic shock (7.8% vs 5.6%, p<0.001), acute kidney injury (AKI) (38.7% vs 28.2%, p<0.001 ), and major adverse cardiovascular and cerebrovascular events (MACCE) (12.6% vs 9.9%, p<0.001 ) than WA patients. Additionally, multivariate analysis revealed AA had increased odds of HF exacerbation (aOR 1.40, 95% CI 1.16-1.70, p<0.001) and AKI (aOR 1.67, 95% CI 1.49-1.88, p<0.001) [Table 1]. Also, AA patients also had a longer length of stay (LOS) (> 7 days for 50.5% of AA versus 39.1% of WA p<0.001), utilized Medicaid more frequently (13.7% versus 4.3%, p<0.001), and incurred higher total charges (median charge of $174,604 versus $161,210, P: <0.01) compared to WA [Table 2]. Conclusion: Racial disparities are evident in the periprocedural outcomes and mortality in CHF patients undergoing ablation for AF. More studies are needed to investigate these findings further and potentially help resolve the disparities.