Key result
Only ~32% of atrial fibrillation trials report race, with even fewer tracking socioeconomic determinants.
Why the study?
Social determinants of health are typically underreported in randomized controlled trials, and it was unknown if this holds true in atrial fibrillation research.
Systematic Review (n=240)
Social determinants of health such as race, ethnicity, and socioeconomic status remain significantly underreported and under-analyzed in contemporary atrial fibrillation RCTs, limiting the generalizability of resulting clinical guidelines.
Limited AF trial generalizability to diverse populations warrants cautious application; challenges reporting standards and extends equity research priorities.
BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Social determinants of health (SDH) have been implicated in the development and outcomes of cardiovascular disease; however, they are typically underreported in randomized controlled trials (RCTs). It is unknown if this holds true in the study of AF. OBJECTIVES: The purpose of this study was to investigate SDH reporting and analysis in AF RCTs. METHODS: A systematic review of AF RCTs in the PubMed database from 10 high-impact journals over the last decade was conducted. One reviewer assessed RCTs for characteristics associated with reporting and analyzing SDH, including demographic and socioeconomic characteristics. Descriptive statistics and logistic regressions were utilized to determine predictors of SDH characteristics. RESULTS: Of 323 RCTs, 240 were included. Nearly all reported age (99.6%) and gender (98.8%), while about 50% analyzed them (56.3% and 49.2%). Less than 33% reported or analyzed race and ethnicity and fewer than 10% addressed socioeconomic characteristics. Studies with increased participants and behavioral or pharmaceutical interventions had greater odds of analyzing age and gender. North American location and higher enrollment was associated with greater odds of reporting and analyzing race. Year of publication was associated with analyzing age and race. CONCLUSIONS: While nearly all studies reported age and gender, a smaller fraction reported and analyzed race, ethnicity, and socioeconomic characteristics. Addressing these gaps is critical to evaluate the role of SDH in patient outcomes, especially in populations that are typically underrepresented in research. The current lack of standardization limits the generalizability of AF RCTs and subsequently developed clinical guidelines.
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Derector et al. (2025) conducted a systematic review in Atrial Fibrillation (RCTs) (n=240). Social determinants of health reporting was evaluated on Reporting of race.
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