Project 467205

Atrial fibrillation (AF) is a common cardiac arrhythmia which affects approximately 200,000 Canadians. Optimal long-term management of AF requires consistent follow-up with medical professionals to adjust and advance therapies. Thus, sufficient access for AF patients to these healthcare services is critical. During my masters, in collaboration with St. Michaels Hospital, I will compare rates of anticoagulation use and catheter ablation for AF patients per census tract with the accessibility of their respective healthcare services (teaching hospitals and ablation centers) in Ontario, Canada. Baseline characteristics for the census tracts will be compared using statistical tests, and an enhanced version of the two-step floating catchment area (2SFCA) will be used to quantify accessibility to healthcare services. The association between access to care, and other factors like age, race, clinical factors and socioeconomic factors with AF outcomes will be explored using multivariate regression. Once this analysis is complete, areas in Ontario where adverse outcomes may be explained by reduced access to healthcare services will be identified. I will then build an integer programming model for resources such as new ablation centres, and identify the optimal placement of these resources to best reduce disparities in access to care across Ontario. The optimization model will incorporate the results of the first analysis and all current resources, with certain constraints on where the new resources can be placed. My work will contribute to the understanding of how geographic accessibility and other factors affect AF outcomes, and in addition, presenting optimal decision making to reduce these differences when planning for new resources.