November 26, 2022
1 min read
Vinter reports no relevant financial disclosures. Please see the study for all other authors’ relevant disclosures.
Among Danish patients with atrial fibrillation who underwent ablation, those living alone, with lower educational attainment or with lower family income were more likely to have a recurrence of AF, researchers reported.
“No study has examined the association between social determinants of health and recurrence of AF after catheter ablation, and current international guidelines for catheter ablation do not address the impact of social determinants of health. Use of social determinants of health as markers for risk of AF recurrence after ablation may be relevant to guide shared decision-making, optimize preventive efforts, and address health care service needs,” Nicklas Vinter, MD, PhD, from Silkeborg Regional Hospital, Denmark, and colleagues wrote.
Recurrent AF was defined as a composite of hospital admission of 1 or more days with AF as the primary diagnosis, cardioversion for AF, a second ablation for AF, or a redeemed prescription of an antiarrhythmic drug. Patients were stratified by whether they lived alone or not; whether they had low, medium or high levels of education; and whether they had low, medium or high levels of family income.
Of the 9,728 patients (mean age, 61 years) selected for the study, 5,881 had AF recurrence over an average of 1.37 years following ablation (recurrence rate, 325.7 per 1,000 person-years; 95% CI, 317.6-334.2). Living alone (HR = 1.07; 95% CI, 1-1.13), lower education (HR for lower vs. higher = 1.09; 95% CI, 1.02-1.17; HR for medium vs. higher = 1.07; 95% CI, 1.01-1.14) and lower income (HR for lower vs. higher = 1.14; 95% CI, 1.06-1.33; HR for medium vs. higher = 1.09; 95% CI, 1.03-1.17) were associated with AF recurrence, the researchers wrote.
The association between AF recurrence and family income was stronger among patients younger than 65 years; No evidence was found between sex or prior HF with social determinants of health.
“Our results may imply that a strategy that aggressively targets risk factor modification in those with worse socioeconomic circumstances could reduce inequality in AF recurrence. It is well-known that specialized nurse-led AF clinics are of great benefit in improving patient compliance and clinical outcomes. Expansion of such clinics for patients undergoing ablation, especially for those with lower socioeconomic circumstances, may be of benefit,” Vinter and colleagues wrote.