ArticleQJM : monthly journal of the Association of Physicians2024
Social determinants of health and clinical outcomes among patients with atrial fibrillation: evidence from a global federated health research network.
Article in QJM : monthly journal of the Association of Physicians, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed, 12 citations in OpenAlex.
- Clustering of Social Determinants of Health and Their Association With Adverse Cardiovascular Outcomes in Atrial Fibrillation.Journal of the American Heart Association · 2026Article
- Physical activity and risk of adverse events in atrial fibrillation: evidence from European and Asian cohorts.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Sex differences in the association of social determinants of health and adverse cardiovascular outcomes in patients with atrial fibrillation.Open heart · 2025Article
- Persistent disparities in diabetic retinopathy outcomes among socially deprived individuals despite treatment adherence.Eye (London, England) · 2025Article
- Adherence to the ABC (atrial fibrillation better care) pathway and risk of adverse outcomes in patients with chronic kidney disease: a report from the prospective APHRS-AF registry.The Lancet regional health. Western Pacific · 2025Article
- Adverse Events and Clinical Correlates in Asian Patients with Atrial Fibrillation and Diabetes Mellitus: A Report from Asia Pacific Heart Rhythm Society Atrial Fibrillation Registry.Journal of clinical medicine · 2024Article
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Authors and funding
7 authors at 2 institutions in 3 countries.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundFew studies have investigated the role of social determinants of health (SDoH) in patients with atrial fibrillation (AF).
aimTo investigate the relationship between SDoH and adverse events in a large multinational AF cohort.
designRetrospective study utilizing a global federated health research network (TriNetX).
methodsPatients with AF were categorized as socially deprived defined according to ICD codes based on three SDoHs: (i) extreme poverty; (ii) unemployment; and/or (iii) problems related with living alone. The outcomes were the 5-year risk of a composite outcomes of all-cause death, hospitalization, ischemic heart disease (IHD), stroke, heart failure (HF) or severe ventricular arrhythmias. Cox regression was used to compute hazard rate ratios (HRs) and 95% confidence intervals (CIs) following 1:1 propensity score matching (PSM).
resultsThe study included 24 631 socially deprived (68.8 ± 16.0 years; females 51.8%) and 2 462 092 non-deprived AF patients (75.5 ± 13.1 years; females 43.8%). Before PSM, socially deprived patients had a higher risk of the composite outcome (HR 1.9, 95% CI 1.87-1.93), all-cause death (HR 1.34, 95% CI 1.28-1.39), hospitalization (HR 2.01, 95% CI 1.98-2.04), IHD (HR 1.67, 95% CI 1.64-1.70), stroke (HR 2.60, 95% CI 2.51-2.64), HF (HR 1.91, 95% CI 1.86-1.96) and severe ventricular arrhythmias (HR 1.83, 95% CI 1.76-1.90) compared to non-deprived AF patients. The PSM-based hazard ratios for the primary composite outcome were 1.54 (95% CI 1.49-1.60) for the unemployed AF patients; 1.39 (95% CI 1.31-1.47) for patients with extreme poverty or with low income; and 1.42 (95% CI 1.37-1.47) for those with problems related with living alone.
conclusionsIn patients with AF, social deprivation is associated with an increased risk of death and adverse cardiac events. The presence of possible unmeasured bias associated with the retrospective design requires confirmation in future prospective studies.
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