Regional and racial outcomes in mortality after atrial fibrillation ablation in medicare Fee for service patients

Background Catheter ablation of Atrial Fibrillation (AF) is a cornerstone of treatment. Data on regional and racial variations in AF ablation procedural mortality are limited. Methods Data were abstracted from the 2016–2019 Medicare Fee for Service database (FFS), including inpatient and outpatient visits to evaluate regional and racial differences in 30-day AF ablation mortality in Medicare FFS patients. Patients with an AF diagnosis who had AF ablation were identified via ICD-10, CPT, and MS-DRG codes. The primary outcome was between-region (Northeast, Midwest, South, West) differences in 30-day mortality which was assessed using logistic regression models; multivariable models controlled for race, comorbid COPD, and CHA2DS2-VASc score. Results 38,477 inpatient and 128,544 outpatient AF ablations met inclusion criteria. AF ablation was most common in the South (inpatient: 17,415, outpatient: 55,932) and least in the Northeast which had a 28% lower adjusted odds of 30-day mortality following inpatient AF ablation compared to the South (NE: 1.75.% vs. S: 2.55%; aOR: 0.72, 95% CI: 0.60–0.88) and 23% lower adjusted odds compared to the West (NE: 1.75% vs. W: 2.30%; aOR: 0.81, 95% CI: 0.66–0.99). In outpatients, the Northeast had 44% lower adjusted odds of 30-day mortality compared to the West (NE: 0.15% vs. W:0.25%; aOR 0.56, 95% CI: 0.36–0.87) and the West had a 73% greater odds of 30-day mortality compared to the South (W: 0.25% vs. S: 0.16%; aOR: 1.73, 95% CI: 1.27–2.36). Non-white patients had higher mortality in the outpatient cohort. Conclusions Within this Medicare FFS population, significant variations in mortality exist following AF ablation when analyzed across different regions and race. Further research on potential systemic and patient level factors would be of value to help elucidate why these differences are present.