Individual and Community‐Level Differences in Use of Contemporary Electrophysiology Procedures in the United States

BACKGROUND: Although the availability of electrophysiology technologies has expanded in the United States, little is known about how sociodemographic factors influence their use. This national study of the Medicare population aims to (1) examine trends in the use of contemporary electrophysiology procedures and (2) assess associations between sociodemographic factors and population-level use of these procedures. METHODS: We identified Medicare beneficiaries who underwent pulmonary vein isolation, left atrial appendage occlusion, leadless pacemaker implantation, or subcutaneous implantable cardioverter-defibrillator implantation from 2018 to 2021 using Current Procedural Terminology codes. Procedural rates were calculated per 100 000 person-years among all eligible Medicare beneficiaries. We compared the rates of each procedure across sociodemographic characteristics (including sex, race, census region, and social vulnerability index) by reporting rate ratios adjusted for age and comorbidities. RESULTS: A total of 425 242 electrophysiology procedures performed between 2018 and 2021 were included. During the study period, use rates of pulmonary vein isolation, left atrial appendage occlusion, and leadless pacemaker increased steadily, whereas subcutaneous implantable cardioverter-defibrillator use declined. In adjusted models, individuals identifying as Black or categorized as other race were less likely to undergo a pulmonary vein isolation, left atrial appendage occlusion, and leadless pacemaker procedure but were more likely to receive a subcutaneous implantable cardioverter-defibrillator. Beneficiaries in less socially vulnerable areas were more likely to receive pulmonary vein isolation, left atrial appendage occlusion, and leadless pacemaker but less likely to undergo subcutaneous implantable cardioverter-defibrillator implantation. Regional variation showed higher use rates in the South and West of the United States. CONCLUSIONS: Significant sociodemographic differences in the use of contemporary electrophysiology procedures persist across communities in the United States. Targeted efforts are needed to ensure that use aligns with clinical need.