Abstract 4358715: Racial and Insurance Disparities in Left Atrial Appendage Occlusion Referrals Among Atrial Fibrillation Patients: A National Inpatient Sample Study (2018–2023)

Background: Left Atrial Appendage Occlusion (LAAO) is a critical intervention for stroke prevention in patients with atrial fibrillation who are unsuitable for long-term anticoagulation. Despite its efficacy, disparities in referral rates for LAAO based on race and insurance type remain underexplored. This study evaluates the rates of LAAO referrals among atrial fibrillation patients across different racial groups and insurance types using data from the National Inpatient Sample (NIS). Objective: To evaluate disparities in referral rates for left atrial appendage occlusion among patients with atrial fibrillation, specifically examining differences across racial groups and insurance types using data from the National Inpatient Sample. Methods: We conducted a retrospective cohort study using the NIS from 2018 to 2023. Adult patients (≥18 years) with a diagnosis of atrial fibrillation were identified using validated ICD-10 codes. Patients were stratified by race (White, Black, Hispanic, Asian) and primary payer type (Private Insurance vs. Medicaid/Medicare). Referrals for LAAO were identified using procedure-related billing and referral codes. Patients with missing race or insurance data were excluded. Chi-square tests were used to compare referral rates across groups, with statistical significance set at p < 0.05. Results: Among 4,500 atrial fibrillation patients analyzed, 62% were White, 18% Black, 12% Hispanic, and 8% Asian. Overall, referral rates for LAAO were significantly higher among patients with private insurance (68%) compared to those with Medicaid/Medicare (47%) (p < 0.01). Referral disparities were evident across all racial groups. Among White patients, referral rates were 72% (private) vs. 50% (Medicaid/Medicare); for Black patients, 58% vs. 35%; for Hispanic patients, 60% vs. 38%; and for Asian patients, 65% vs. 42%, respectively. Black patients with Medicaid/Medicare had the lowest referral rate of any subgroup. Conclusion: Disparities in LAAO referral rates are evident across racial and insurance groups, with Medicaid/Medicare recipients, particularly Black patients, being significantly less likely to receive referrals for LAAO. Addressing these disparities is crucial to ensure equitable access to stroke prevention strategies in atrial fibrillation care.