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Kotta PA, Nambi V, Misra A, Afshar H, Chelu MG, Nasir K, Abramov D, Minhas AMK. Association between neighborhood household income and inpatient atrial fibrillation outcomes. Heart Rhythm 2024; 21:993-1000. [PMID: 38382688 DOI: 10.1016/j.hrthm.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The impact of socioeconomic status on the clinical outcomes of patients admitted to the hospital for atrial fibrillation (AF) is not well described. OBJECTIVE The purpose of this study was to determine the association between median neighborhood household income (mNHI) and clinical outcomes among patients admitted to the hospital for AF. METHODS We retrospectively analyzed primary AF hospitalizations from the United States National Inpatient Sample between 2016 and 2020. The analyzed sample was divided into quartiles based on the mNHI in the zip code of the patient's residence. The lowest quartile was used as the reference category. Study outcomes included inpatient procedure utilization (ablation, cardioversion, percutaneous left atrial appendage closure), length of stay, cost, mortality, and disposition. Weighted multivariable logistic and linear regression, adjusting for multiple patient and hospital-level characteristics, was performed. RESULTS Patients in the highest mNHI quartile had lower comorbidity burden, lower in-hospital mortality (odds ratio [OR] 0.78; 95% confidence interval [CI] 0.7-0.87; P <.001), lower discharges to care facility (OR 0.86; 95% CI 0.83-0.9; P <.001), shorter length of stay (adjusted mean difference -0.26; 95% CI -0.30 to -0.22; P <.001), higher procedure utilization, and higher health care costs ($12,124 vs $10,018) compared to the lowest mNHI quartile patients. CONCLUSION We identified significantly higher in-hospital mortality and lower procedural/resource utilization in patients living in lower-income neighborhoods compared to higher-income neighborhoods. Further research is needed to better understand the drivers of these disparities and the strategies to improve health care disparities between socioeconomic groups.
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Affiliation(s)
- Prasanti A Kotta
- Baylor College of Medicine, Department of Internal Medicine, Houston, Texas.
| | - Vijay Nambi
- Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Section of Cardiology, Houston, Texas
| | - Arunima Misra
- Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Section of Cardiology, Houston, Texas
| | - Hamid Afshar
- Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Section of Cardiology, Houston, Texas
| | - Mihail G Chelu
- Baylor College of Medicine, Department of Internal Medicine, Houston, Texas; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas; Texas Heart Institute at Baylor St. Luke's Medical Center, Houston, Texas
| | - Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Section of Cardiology, Houston, Texas
| | - Dmitry Abramov
- Loma Linda, University Health, Department of Cardiology, Loma Linda, California
| | - Abdul Mannan Khan Minhas
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
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Frost L, Johnsen SP, Benjamin EJ, Trinquart L, Vinter N. Social drivers in atrial fibrillation occurrence, screening, treatment, and outcomes: systematic-narrative hybrid review. Eur Heart J Suppl 2024; 26:iv50-iv60. [PMID: 39099579 PMCID: PMC11292415 DOI: 10.1093/eurheartjsupp/suae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
The importance of social drivers of health (SDOH) in the occurrence, detection, treatment, and outcome of atrial fibrillation (AF) has attracted increasing attention. Addressing SDOH factors may suggest opportunities to prevent AF and its complications. We aimed to conduct a structured narrative review and summarize current knowledge on the association between race and ethnicity, SDOH, including rural vs. urban habitation, education, income, and neighbourhood, and the risk of AF, its management, and complications. We identified 537 references in PubMed and 473 references in Embase. After removal of duplicates, we screened the abstracts of 975 references, resulting in 113 references that were examined for eligibility. Subsequently, 34 references were excluded leaving 79 references for the review. Evidence of a social gradient in AF incidence and prevelance were conflicting. However, we found substantial evidence indicating social inequities in the detection of AF, access to treatment, and outcomes such as healthcare utilization, bleeding, heart failure, stroke, dementia, work disability, and death. Inequities are reported across various health care systems and constitute a global problem affecting several continents, although data from Africa and South America are lacking. Given the documented social inequities in AF detection, management, and outcomes, there is an urgent need for healthcare systems, policymakers, and society to identify and implement effective interventions that can reduce inequities and improve outcomes in individuals with AF.
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Affiliation(s)
- Lars Frost
- Department of Cardiology, Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 1, 8600 Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Denmark
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, 715 Albany St, Boston, MA 02118, USA
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
| | - Ludovic Trinquart
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Denmark
- Tufts Clinical and Translational Science Institute, Tufts University, 35 Kneeland St, Boston, MA 02111, USA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Boston, MA 0211, USA
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Nicklas Vinter
- Department of Cardiology, Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 1, 8600 Silkeborg, Denmark
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Denmark
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Simoni AH, Bucci T, Romiti GF, Frydenlund J, Johnsen SP, Abdul-Rahim AH, Lip GYH. Social determinants of health and clinical outcomes among patients with atrial fibrillation: evidence from a global federated health research network. QJM 2024; 117:353-359. [PMID: 38060301 PMCID: PMC11150002 DOI: 10.1093/qjmed/hcad275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/23/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Few studies have investigated the role of social determinants of health (SDoH) in patients with atrial fibrillation (AF). AIM To investigate the relationship between SDoH and adverse events in a large multinational AF cohort. DESIGN Retrospective study utilizing a global federated health research network (TriNetX). METHODS Patients 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). RESULTS The 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. CONCLUSIONS In 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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Affiliation(s)
- A H Simoni
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - T Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of General and Specialized Surgery, Sapienza University of Rome, Rome, Italy
| | - G F Romiti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - J Frydenlund
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - S P Johnsen
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - A H Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Stroke Division, Department of Medicine for Older People, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - G Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
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Zhang X, Wang W, Zeng J, Ye Q, Lai X, Cai X, Diao X, Huang J, Li K. Adherence to the atrial fibrillation better care pathway and its associated factors among rural patients with atrial fibrillation in China: A cross-sectional study. Heart Lung 2024; 66:23-30. [PMID: 38520987 DOI: 10.1016/j.hrtlng.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The atrial fibrillation better care (ABC) pathway is an effective strategy for the integrated management of atrial fibrillation (AF). Current data on adherence to the ABC pathway among rural patients with AF in China are limited. OBJECTIVES To investigated adherence to the ABC pathway and its associated factors among rural patients with AF in China. METHODS In the cross-sectional study, we recruited 870 rural patients with AF from July 2022 to July 2023 in China. AF-related sociodemographic and clinical data was collected. RESULTS Among the 870 rural patients with AF, 437 (50.23 %) were male, 714 (82.07 %) were ≥65 years old. The level of adherence to ABC pathway was extremely low (5.75 %), and its associated factors included patients ≥75 years (compared with those <65 years, OR=0.165, 95 %CI: 0.065-0.417, P < 0.001), junior middle school and senior middle school education or above (compared with primary school education or below, OR=3.441, 95 %CI: 1.144-10.351, P = 0.028; OR=11.438, 95 %CI: 3.758-34.814, P < 0.001), average monthly household income per capita 1000-3000 RMB and >3000 RMB (compared with <1000 RMB, OR=3.993, 95 %CI: 1.343-11.877, P = 0.013; OR=4.474, 95 %CI: 1.478-13.541, P = 0.008), persistent AF (compared with paroxysmal AF, OR=0.062, 95 %CI: 0.008-0.466, P = 0.007) and multimorbidity (OR=0.356, 95 %CI: 0.163-0.781, P = 0.010). CONCLUSIONS There is an urgent need to develop targeted interventions and national policies to improve the adherence to the ABC pathway of rural AF patients in China.
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Affiliation(s)
- Xiaomin Zhang
- School of Nursing, Sun Yat-Sen University, No.74 Zhong Shan Second Road, Guangzhou 510080, China
| | - Wenxuan Wang
- School of Nursing, Sun Yat-Sen University, No.74 Zhong Shan Second Road, Guangzhou 510080, China
| | - Jianqing Zeng
- School of Nursing, Sun Yat-Sen University, No.74 Zhong Shan Second Road, Guangzhou 510080, China
| | - Qirao Ye
- Department of Cardiology, People's Hospital of Shangyou County, Ganzhou, China
| | - Xinwei Lai
- Department of Cardiology, People's Hospital of Shangyou County, Ganzhou, China
| | - Xiaomei Cai
- Chronic Disease Management Center, People's Hospital of Shangyou County, Ganzhou, China
| | - Xiulin Diao
- Department of Cardiology, People's Hospital of Shangyou County, Ganzhou, China
| | - Jun Huang
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhong Shan Second Road, Guangzhou 510080, China
| | - Kun Li
- School of Nursing, Sun Yat-Sen University, No.74 Zhong Shan Second Road, Guangzhou 510080, China.
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Won D, Workman C, Walker J, Zordani E, Bajaj P, Chen Z, Asthana S, Liu T, Christopher Malaisrie S, McCarthy DM, Adams JG, Lundberg A. When the economy falters, hearts suffer: Economic recessions as a social determinant of health in cardiovascular emergencies. Am J Emerg Med 2024; 76:155-163. [PMID: 38086181 DOI: 10.1016/j.ajem.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION While the relationships between cardiovascular disease (CVD), stress, and financial strain are well studied, the association between recessionary periods and macroeconomic conditions on incidence of disease-specific CVD emergency department (ED) visits is not well established. OBJECTIVES This retrospective observational study aimed to assess the relationship between macroeconomic trends and CVD ED visits. METHODS This study uses data from the National Hospital Ambulatory Care Survey (NHAMCS), Federal Reserve Economic Database (FRED), National Bureau of Economic Research (NBER), and CVD groupings from National Vital Statistics (NVS) and Center for Medicare and Medicaid Services (CMS) from 1999 to 2020 to analyze ED visits in relation to macroeconomic indicators and NBER defined recessions and expansions. RESULTS CVD ED visits grew by 79.7% from 1999 to 2020, significantly more than total ED visits (27.8%, p < 0.001). A national estimate of 213.2 million CVD ED visits, with 22.9 million visits in economic recessions were analyzed. A secondary group including a 6-month period before and after each recession (defined as a "broadened recession") was also analyzed to account for potential leading and lagging effects of the recession, with a total of 50.0 million visits. A significantly higher proportion of CVD ED visits related to heart failure (HF) and other acute ischemic heart diseases (IHD) was observed during recessionary time periods both directly and with a 6-month lead and lag (p < 0.05). The proportion of aortic aneurysm and dissection (AAA) and atherosclerosis (ASVD) ED visits was significantly higher (p = 0.024) in the recession period with a 6-month lead and lag. When controlled for common demographic factors, economic approximations of recession such as the CPI, federal funds rate, and real disposable income were significantly associated with increased CVD ED visits. CONCLUSION Macroeconomic trends have a significant relationship with the overall mix of CVD ED visits and represent an understudied social determinant of health.
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Affiliation(s)
- Daniel Won
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Connor Workman
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - James Walker
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Elizabeth Zordani
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Pranav Bajaj
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Zhanlin Chen
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Shravan Asthana
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Tom Liu
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - S Christopher Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Danielle M McCarthy
- Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - James G Adams
- Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Alex Lundberg
- Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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