Diversity, equity, and inclusion in arrhythmia care: a European Heart Rhythm Association survey

Disparities in arrhythmia care are increasingly recognized, yet remain incompletely characterized across the patient pathway. This European Heart Rhythm Association (EHRA) survey explored clinician-reported perceptions of inequity across diagnosis, pharmacological management, procedural referral, and follow-up.

A 30-question survey was disseminated via the EHRA between November 2025 and January 2026, with 212 responses from professionals across 35 countries. Respondents were predominantly consultant electrophysiologists (67.5%), with 39.6% identifying as female. Most (68.4%) reported no prior training in equity or inclusive care. Across the arrhythmia care pathway, disparities were most frequently attributed to patient vulnerability, particularly cognitive impairment (72.5%), age >80 years (63.8%), and mental health disease (61.3%). Differences related to socioeconomic status, language, and other social factors were also commonly reported. Female sex and minority ethnic background were each reported to influence care in 24.1% of responses. Age >80 years was consistently identified as the strongest determinant of disparities in referral, diagnosis, and outcomes, influencing referral for arrhythmia evaluation (65.8%), catheter ablation (77.9%), and outcomes following ablation (68.1%). Socioeconomic and ethnic factors showed more modest but consistent effects, while sex-based differences were less frequently reported. However, female respondents were more likely than male respondents to report delayed referral (female respondents: 41.8%; male respondents: 19.8%) and late or incorrect diagnosis (49.4 vs. 15.8%) in female patients, as well as delayed referral for catheter ablation (36.5 vs. 10.3%) and device implantation (23.0 vs. 7.0%). Only one-third of respondents (33.3%) felt that current international guidelines adequately address diversity, equity, and inclusion in arrhythmia care.

Clinicians perceive disparities in arrhythmia care across multiple patient and social factors. Whilst age and vulnerability were most frequently perceived to influence care, sex and ethnicity were also recognized by a substantial proportion of respondents. Perceptions varied according to respondent characteristics, with female clinicians more likely to report disparities amongst female patients. Limited training and institutional frameworks highlight opportunities for targeted interventions.