Abstract
Byline: Eva M Holland, Sch of Medicine, Creighton Univ Sch of Med, Omaha, NE; Ryan W Walters, Creighton Univ, Omaha, NE; Michael H Kim, Creighton Univ Sch of Med, Omaha, NE Introduction: Prior data report female sex, race, and impoverished populations by income and insurance status as less likely to receive atrial fibrillation (AF) ablation. Beyond this disparity, the impact of Social Determinants of Health (SocDH) in those that receive AF ablation and clinical outcomes is unknown. Using Health-Related Social Needs (HRSNs) as an indicator of SocDH, we assessed hospital readmissions after AF ablation. Methods: The 2010-2019 Nationwide Readmissions Database was queried for ICD-9/10 procedure and diagnosis codes for hospitalizations in which an adult patient underwent AF ablation and then stratified by presence of HRSNs (housing, socioeconomic status [SES], family, employment, and psychosocial) using Z-codes. Outcomes included all-cause 90-day readmission, and length of stay (LOS) and cost at index hospitalization. Unadjusted and adjusted regression models were estimated controlling for age, sex, and comorbidity burden. Results: An estimated 215,640 hospitalizations included AF ablation, of which 0.3% included a patient with a HRSN where housing and SES insecurity were the two most common HRSNs (43% and 40%, respectively). Hospitalizations including a HRSN tended to include younger patients (63 vs. 67 years), male (70% vs. 61%), a lower income quartile, with less private insurance (10% vs. 30%; all p < .001). HRSNs were associated with a 84% higher unadjusted odds of readmission (p < .001); although, this association was reduced to 15% after adjustment (p = .299). Readmission causes were identical between groups (18% and 15%, respectively). At index hospitalization, after adjustment, HRSNs were associated with 76% longer LOS (p < .001) and 7% higher hospital cost (p = .024). Conclusions: HRSNs/SocDH were associated with significant cost and LOS increases during index AF Ablation hospitalization. All-cause 90-day readmissions were increased, but not significant after adjustment for clinical factors. Compared to the general AF population, those receiving AF ablations had lower prevalence of HRSNs (0.3 vs. 0.9%). Further study on the impact of HRSNs in AF patients regarding rhythm control, AF ablation, and clinical outcomes is needed. A lower prevalence of HRSNs suggests a disparity in AF ablation application.