Social determinants of health and recurrence of atrial fibrillation after catheter ablation. A Danish nationwide cohort study

Nicklas Vinter*, Peter Calvert, Mads Brix Kronborg, Jens Cosedis-Nielsen, Dhiraj Gupta, Wern Yew Ding, Ludovic Trinquart, Søren Paaske Johnsen, Lars Frost, Gregory Y H Lip

*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review


AIM: To examine the associations between three social determinants of health (SDOH) and recurrence of AF after ablation.

METHODS: We selected patients who underwent a first ablation after an incident hospital diagnosis of AF between 2005 and 2018 from the entire Danish population. Educational attainment, family income, and whether the patient was living alone were assessed at the time of ablation. We used cause-specific proportional hazard models to estimate hazard ratios (HR) with 95% CI adjusted for age and sex. In secondary analyses, we adjusted for comorbidities, antiarrhythmic medication, and prior electrical cardioversion.

RESULTS: We selected 9,728 patients (mean age 61 years, 70% men), and 5,881 patients had AF recurrence over an average of 1.37 years after ablation (recurrence rate 325.7 (95%CI 317.6-334.2) per 1000 person-years). Lower education (HR 1.09 [1.02-1.17] and 1.07 [1.01-1.14] for lower and medium vs. higher), lower income (HR 1.14 [1.06-1.22] and 1.09 [1.03-1.17] for lower and medium vs. higher), and living alone (HR 1.07 [1.00-1.13]) were associated with increased rates of recurrence of AF. We found no evidence of interaction between sex or prior HF with SDOH. The association between family income and AF recurrence was stronger among patients <65 years compared to those aged ≥65 years. The associations between SDOH and AF recurrence did not persist in the multivariable model.

CONCLUSIONS: AF was more likely to recur among patients with lower educational attainment, lower family income, or those living alone. Multidisciplinary efforts are needed to reduce socioeconomic inequity in the effect of ablation.

Original languageEnglish
JournalEuropean heart journal - Quality of care & clinical outcomes
Pages (from-to)632–638
Number of pages7
Publication statusPublished - 12 Sept 2023


  • Atrial Fibrillation/epidemiology
  • Catheter Ablation
  • Cohort Studies
  • Denmark/epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Social Determinants of Health


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