Sex Differences in Healthcare Resource Utilization in Patients With Atrial Fibrillation Receiving Dronedarone versus Sotalol Following Ablation

Introduction: Patterns of anti-arrhythmic drug therapy for atrial fibrillation (AF) treatment and outcomes may differ by sex. Dronedarone has shown clinical benefit vs sotalol post-ablation in males and females with AF; however, the impact of these drugs on healthcare resource utilization (HCRU) remains unknown among sex subgroups. Methods: We conducted two retrospective, observational cohort analyses using IBM MarketScan® data (Jan 2012-Mar 2020) in adult male and female patients with AF who received dronedarone or sotalol post-ablation. Patients were required to have had 12 months’ available pre-ablation data; follow-up ended at the earliest of health-plan disenrollment, death or end of data availability (Dec 2020). Prevalence (per 100 patient-years [PY]) during the post-ablation period was calculated for all-cause HCRU (hospitalizations; emergency room [ER] visits; outpatient office visits; other outpatient services). Patients receiving sotalol were propensity score matched 1:1 to patients receiving dronedarone and outcomes were compared using univariate generalized linear models with Poisson distribution. Results: In females (n=460 per cohort ; age at ablation: ~64 years; mean follow-up: ~29 months; prior heart failure: ~14.6%; mean Charlson comorbidity index [CCI]: ~0.8), post-ablation prevalence of ER visits, outpatient office visits, and other outpatient services were significantly lower with dronedarone than sotalol (Table). In males (n=1112 per cohort; age at ablation: ~60 years; mean follow-up: ~29 months; prior heart failure: ~12%; mean CCI: ~0.8), post-ablation prevalence of hospitalizations was significantly lower with dronedarone than sotalol, but other HCRU measures were similar. Conclusions: In females post-AF ablation, dronedarone was generally associated with lower HCRU than sotalol. In males, dronedarone was associated with lower hospitalization prevalence than sotalol, but other HCRU was similar.