Evaluation of sex differences in the receipt of concomitant atrial fibrillation procedures during nonmitral cardiac surgery

Catherine M Wagner; Patricia F Theurer; Melissa J Clark; Chang He; Carol Ling; Edward Murphy; James Martin; Steven F Bolling; Donald S Likosky; Michael P Thompson; Francis D Pagani; Gorav Ailawadi; Robert B Hawkins

doi:10.1016/j.jtcvs.2024.04.011

Evaluation of sex differences in the receipt of concomitant atrial fibrillation procedures during nonmitral cardiac surgery

J Thorac Cardiovasc Surg. 2024 Apr 29:S0022-5223(24)00309-X. doi: 10.1016/j.jtcvs.2024.04.011. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, Ann Arbor, Mich.
² Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich.
³ SHMG Cardiothoracic Surgery, Corewell Health, Grand Rapids, Mich.
⁴ Center for Cardiovascular and Thoracic Surgery, McLaren Flint Hospital, Flint, Mich.
⁵ Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
⁶ Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich.
⁷ Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich. Electronic address: Robertbh@med.umich.edu.

PMID: 38692480
DOI: 10.1016/j.jtcvs.2024.04.011

Abstract

Objective: Women are less likely to receive guideline-recommended cardiovascular care, but evaluation of sex-based disparities in cardiac surgical procedures is limited. Receipt of concomitant atrial fibrillation (AF) procedures during nonmitral cardiac surgery was compared by sex for patients with preoperative AF.

Methods: Patients with preoperative AF undergoing coronary artery bypass grafting and/or aortic valve replacement at any of the 33 hospitals in Michigan from 2014 to 2022 were included. Patients with prior cardiac surgery, transcatheter AF procedure, or emergency/salvage status were excluded. Hierarchical logistic regression identified predictors of concomitant AF procedures, account for hospital and surgeon as random effects.

Results: Of 5460 patients with preoperative AF undergoing nonmitral cardiac surgery, 24% (n = 1291) were women with a mean age of 71 years. Women were more likely to have paroxysmal (vs persistent) AF than men (80% vs 72%; P < .001) and had a higher mean predicted risk of mortality (5% vs 3%; P < .001). The unadjusted rate of concomitant AF procedure was 59% for women and 67% for men (P < .001). After risk adjustment, women had 26% lower adjusted odds of concomitant AF procedure than men (adjusted odds ratio, 0.74; 95% CI, 0.64-0.86; P < .001). Female sex was the risk factor associated with the lowest odds of concomitant AF procedure.

Conclusions: Women are less likely to receive guideline recommended concomitant AF procedure during nonmitral surgery. Identification of barriers to concomitant AF procedure in women may improve treatment of AF.

Keywords: atrial fibrillation; health equity; quality; sex disparities.