Evaluation of sex differences in the receipt of concomitant atrial fibrillation procedures during non-mitral cardiac surgery.

OBJECTIVE: Females 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 non-mitral 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 2014-2022 were included. Patients with prior cardiac surgery, transcatheter AF procedure, or emergent/salvage status were excluded. Hierarchical logistic regression identified predictors of concomitant AF procedures, account for hospital and surgeon as random effects.

RESULTS: Of 5,460 patients with preoperative AF undergoing non-mitral cardiac surgery, 24% (n=1,291) were female with a mean age of 71. Females were more likely to have paroxysmal (versus persistent) AF than males (80% vs 72%, p<0.001) and had a higher mean predicted risk of mortality (5% vs 3%, p<0.001). The unadjusted rate of concomitant AF procedure was 59% for females and 67% for males(p<0.001). After risk adjustment, females had 26% lower adjusted odds of concomitant AF procedure than males (ORadj :0.74, (95%CI 0.64-0.86), p<0.001). Female sex was the risk factor associated with the lowest odds of concomitant AF procedure.

CONCLUSIONS: Females are less likely to receive guideline recommended concomitant AF procedure during non-mitral surgery. Identification of barriers to concomitant AF procedure in females may improve treatment of AF.