Association of Atrial Fibrillation Symptom Burden With Social Determinants of Health

BACKGROUND: Social determinants of health (SDoH) may influence the clinical presentation, management, and outcomes related to atrial fibrillation (AF). OBJECTIVES: This study aims to examine the associations of SDoH with trajectories in AF symptom burden in participants undergoing AF treatment. METHODS: The authors designed a prospective, observational cohort study at an academic medical center in a large U.S. metropolitan city serving predominantly low-income and underinsured populations. Participants were those referred with an initial diagnosis of paroxysmal or persistent AF. Adverse SDoH, including NDI (National Deprivation Index), insurance status, language, and marital status, as well as proxies for structural and systemic biases through race, ethnicity, and sex were assessed. Participants received standard care with study-specific follow-up at 1 year. The outcome was scores from the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire (higher scores representing better quality of life). RESULTS: Of 515 participants who had follow-up assessments; 41% were non-Hispanic Black, 40% were non-Hispanic White, and 18% were Hispanic/Latinx. The mean AFEQT score at baseline was 73 (of 100) and at follow-up was 80 (SD: 19). Participants living in higher levels of NDI experienced 6.4 (95% CI: 1.9-11.0) point smaller increase in AFEQT scores compared to those in lower levels of NDI, and non-Hispanic Blacks experienced a 4.6 (95% CI: 1.1-8.0) point smaller increase compared to non-Hispanic Whites. There were 61 admissions for decompensated heart failure, 53 ischemic strokes, and 47 all-cause mortality events. CONCLUSIONS: After adjusting for clinical factors, adverse SDoH associate with blunted improvements in AF symptom burden after 1 year of clinical management.