Inequitable Access to Catheter Ablation for Atrial Fibrillation and Adverse Outcomes in a Publicly Funded Healthcare System.

Background: Although all Canadians have universal coverage for hospital-based care, only limited data describe the determinants of access to catheter ablation for atrial fibrillation (AF) in Canada. Methods: This population-based cohort study from Alberta, Canada (2013-2020) included adults (age ≥ 18 years) with new-onset AF in whom a rhythm-control strategy was desired. Factors associated with ablation within 5 years were identified using multivariable logistic regression models. The association between ablation and outcomes was assessed in a propensity score-matched cohort using Cox proportional hazard models; the time to ablation was treated as a time-varying covariate to mitigate immortal time bias. Results: Of 11,844 patients, 8.7% (n = 1014) received ablation within 5 years of diagnosis. The mean cohort age was 64.6 ± 14.0 years; 35.1% were female; and the mean Conclusion: There are disparities in ablation rates based on demographic and socioeconomic factors. Lack of access to ablation is associated with poorer clinical outcomes at 5 years. Our results support the importance of equity-driven health services planning and advocacy to ensure fair access to ablation.