Policy, Payment & Practice -> Clinical Quality Measures and Outcomes D-PO02 - Poster Session II (ID 47) Poster

D-PO02-117 - Location, Location, Location: Rural Patients Trial More AADs Before First Time AF Ablation (ID 214)


Background: Rural and urban practice patterns often lead to differences in care before patients are treated at referral centers. University of Colorado serves a wide geographical area with referrals from rural areas of Colorado and bordering states.
Objective: Assess AF patient population and treatment trends in rural vs urban populations.
Methods: We assessed our NCDR submission data from Jan 2017 to Aug 2019 for differences in AAD use of our rural (n=236) vs urban (n=180) patients who underwent first time AF ablation. Our rural patient classification was made based on those patients whose zip codes were outside the Denver/Colorado Springs/Boulder metropolitan areas.
Results: Baseline characteristics showed no significant differences in sex (60% male), age (65 +/- 10 years)), LVEF (52 +/- 13%), AF class (36% persistent, 64% paroxysmal), CHADS2VASC (2.5), HASBLED (0.5), or anticoagulant choice. There were differences only in BMI (30.7 vs 28.8 kg/m^2, p=0.002) and systolic blood pressure (135 vs 130mmHg, p=0.007). More rural patients (141 vs 76, p=0.002) had trialed at least 1 AAD prior to presenting for AF ablation. There were also differences in the choice of AAD with flecainide favored in rural patients and dofetilide in urban patients (see figure).
Conclusion: Many similarities exist between urban and rural populations. However, rural patients presenting for first time AF ablation appear to be more likely to have trialed AAD therapy and tend to prefer AADs that can be started without hospitalization.