Published in

Oxford University Press, European Heart Journal - Quality of Care and Clinical Outcomes, 2022

DOI: 10.1093/ehjqcco/qcac071

Links

Tools

Export citation

Search in Google Scholar

Social determinants of health and recurrence of atrial fibrillation after catheter ablation: a Danish nationwide cohort study

This paper was not found in any repository, but could be made available legally by the author.
This paper was not found in any repository, but could be made available legally by the author.

Full text: Unavailable

Green circle
Preprint: archiving allowed
Orange circle
Postprint: archiving restricted
Red circle
Published version: archiving forbidden
Data provided by SHERPA/RoMEO

Abstract

Abstract Aims To examine the associations between three social determinants of health (SDOH) and recurrence of AF after ablation. Methods and results 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% confidence interval (CI) adjusted for age and sex. In secondary analyses, we adjusted for comorbidities, antiarrhythmic medication, and prior electrical cardioversion. We selected 9728 patients (mean age 61 years, 70% men), and 5881 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 with those aged ≥ 65 years. The associations between SDOH and AF recurrence did not persist in the multivariable model. Conclusion 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.