TY - JOUR

T1 - Social determinants of health and recurrence of atrial fibrillation after catheter ablation. A Danish nationwide cohort study

AU - Vinter, Nicklas

AU - Calvert, Peter

AU - Kronborg, Mads Brix

AU - Cosedis-Nielsen, Jens

AU - Gupta, Dhiraj

AU - Ding, Wern Yew

AU - Trinquart, Ludovic

AU - Johnsen, Søren Paaske

AU - Frost, Lars

AU - Lip, Gregory Y H

N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2022/10/27

Y1 - 2022/10/27

N2 - 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.

AB - 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.

U2 - 10.1093/ehjqcco/qcac071

DO - 10.1093/ehjqcco/qcac071

M3 - Journal article

C2 - 36302141

JO - European heart journal. Quality of care & clinical outcomes

JF - European heart journal. Quality of care & clinical outcomes

SN - 2058-1742

ER -