Socioeconomic Disparities in Access for Watchman Device Insertion in Patients with Atrial Fibrillation and at Elevated Risk of Bleeding

Background: As the Watchman device is new, no studies have yet reported on healthcare disparity issues in this population. We sought to investigate socioeconomic and racial disparities among select atrial fibrillation (AF) patients who did or did not receive Watchman device placement. Methods: This retrospective case-control study included patients with non-valvular AF requiring long-term anticoagulation who underwent left atrial appendage (LAA) exclusion with the Watchman device at our institution from June 2015 to December 2016. A control group was designed by medical records query for patients with non-valvular AF requiring long-term anticoagulation with an elevated risk of bleeding (defined by hospital admission for major bleeding episodes and discharged off anticoagulation), but not referred for LAA closure within the study period. Differences in median income, type of insurance coverage, race, sex, and age were analyzed. Results: Of 201 patients, 98 received the Watchman device (intervention) and 103 did not (control). The mean estimated income was significantly higher for intervention than control patients ($70,908.50 ± $25,847.20 vs. $56,569.90 ± $17,730.90; p < 0.001). African-American patients were less likely to receive the Watchman insertion (5% vs. 27%; p < 0.001). Control patients had a higher percentage with Medicaid by both primary (6% vs. 0; p = 0.029) and dual coverage of Medicare and Medicaid (13% vs. 4%; p = 0.041). No significant difference occurred in gender. Conclusion: Socioeconomic and racial disparities exist in patients with non-valvular AF at elevated risk of bleeding. African-American patients with lower income and Medicaid are less likely to be referred for the Watchman device.