Why the study?
AF management requires continuous patient engagement and integrative healthcare, prompting exploration of the association between adverse clinical outcomes and educational attainment or insurance plan.
Do sociodemographic factors like educational attainment and insurance plan impact the incidence of all-cause mortality, ischaemic stroke, and major bleeding in patients with non-valvular AF?
Do sociodemographic factors like educational attainment and insurance plan impact the incidence of all-cause mortality, ischaemic stroke, and major bleeding in patients with non-valvular AF?
Lower educational attainment is independently associated with earlier all-cause mortality and ischaemic stroke in patients with non-valvular AF, highlighting the impact of social determinants of health on cardiovascular outcomes.
BACKGROUND: Atrial fibrillation (AF) is a complex disease. The management of AF requires continuous patient engagement and integrative healthcare. OBJECTIVES: To explore the association between adverse AF-related clinical outcomes and the following two sociodemographic factors: educational attainment and insurance plan. DESIGN: A nationwide, prospective, multicenter, cohort trial. SETTING: National registry of 3402 patients with non-valvular AF in Thailand. PARTICIPANTS: All patients enrolled in the registry, except those with missing information on educational attainment or insurance plan. Finally, data from 3026 patients (mean age 67 years, SD 11.3; 59% male sex) were analysed. PRIMARY OUTCOMES: Incidences of all-cause mortality, ischaemic stroke and major bleeding during the 36-month follow-up period. Survival analysis was performed using restricted mean survival time (RMST) and adjusted for multiple covariates. The levels of the educational attainment were as follows: no formal education, elementary (grade 1-6), secondary (grade 7-12) and higher education (tertiary education). RESULTS: The educational attainment of the majority of patients was elementary (N=1739, 57.4%). The predominant health insurance plans were the Civil Servant Medical Benefit Scheme (N=1397, 46.2%) and the Universal Coverage Scheme (N=1333, 44.1%). After 36 months of follow-up, 248 patients died (8.2%), 95 had ischaemic stroke (3.1%) and 136 had major bleeding (4.5%). Patients without formal education died 1.78 months earlier (adjusted RMST difference -1.78; 95% CI, -3.25 to -0.30; p=0.02) and developed ischaemic stroke 1.04 months sooner (adjusted RMST difference -1.04; 95% CI, -2.03 to -0.04; p=0.04) than those attained a level of higher education. There were no significant differences in RMSTs for all three clinical outcomes when considering the type of health insurance plan. CONCLUSION: Educational attainment was independently associated with all-cause mortality and ischaemic stroke in patients with AF, but adverse clinical outcomes were not related to the types of health insurance in Thailand. TRIAL REGISTRATION NUMBER: Thai Clinical Trial Registration; Study ID: TCTR20160113002.
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Apiyasawat et al. (2022) studied this question.
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