New study finds disparities in cardiac arrhythmia treatment
A large, population-based study has found cardiac ablation for ventricular tachycardia (VT) procedures is more likely to be performed on patients who are white males from wealthier neighborhoods.
Conversely, Black women and patients from disadvantaged areas are the least likely to undergo the heart procedure used to control this life-threatening heart rhythm, according to new research from the University of Wisconsin School of Medicine and Public Health.
The study was published in the Journal of the American Heart Association.
Lead author Dr. Ryan Kipp, associate professor of medicine, UW School of Medicine and Public Health, and cardiologist, UW Health, led a team that analyzed data from 131,645 Medicare patients who were admitted to a hospital with VT, a rhythm problem that causes life-threatening rapid heartbeats.
While VT can be controlled with medication, an ablation procedure can be a safe and reliable way to improve control of the rhythm, particularly when medications are not effective or have side effects. During this procedure, the electrophysiologist threads a catheter to the heart to identify the location of the arrhythmia and scar the part of the heart muscle that is sending the faulty electrical signals, thus preventing VT from recurring.
The team looked at data from patients admitted for VT between Jan. 1 to Nov. 30, 2014. They found that 2,190 patients, or about 1.66%, received ablations. The procedures were not evenly distributed across the patient population. Women were 25% less likely to receive them than men, and Black patients were 25% less likely to receive them than white patients. Overall, Black women had a 50% lower rate of receiving ablations than white men.
Researchers also analyzed the patients’ neighborhoods and found that those from the most socioeconomically disadvantaged areas were 19% less likely to receive an ablation.
Researchers parsed the data to assess whether other comorbid conditions, such as obesity or kidney failure, were driving the decisions, and also did a separate analysis of patients with previous heart attacks or implantable defibrillators. In all analyses, race, sex and neighborhood disadvantage predicted which patients received ablations.
“Our results show that the benefits of VT ablation are differently delivered, with historically under-resourced groups least likely to receive advanced care,’’ Kipp said. “One plausible explanation is implicit bias or systemic racism.”
Kipp called the disparities “quite significant,” and said other factors likely contribute, including provider education about whom to refer to electrophysiology and when to refer them. Patient access to health care, trust in the health care system and social stressors could also affect their decisions to move forward with the procedure, he said.
Though the data are from eight years ago, it is unlikely the disparities have disappeared, and because COVID-19 hit Black and disadvantaged communities harder, it is likely that the pandemic worsened VT treatment disparities, according to Kipp. More research is needed to understand what is causing this disparity and how to change practices to deliver more equitable care, he said.
Other faculty on the research team include Drs. Matthew Kalscheur, Ann Sheehy, Christie Bartels, Amy Kind and W. Ryan Powell.