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Social determinants of atrial fibrillation

Abstract

Atrial fibrillation affects almost 60 million adults worldwide. Atrial fibrillation is associated with a high risk of cardiovascular morbidity and death as well as with social, psychological and economic burdens on patients and their families. Social determinants — such as race and ethnicity, financial resources, social support, access to health care, rurality and residential environment, local language proficiency and health literacy — have prominent roles in the evaluation, treatment and management of atrial fibrillation. Addressing the social determinants of health provides a crucial opportunity to reduce the substantial clinical and non-clinical complications associated with atrial fibrillation. In this Review, we summarize the contributions of social determinants to the patient experience and outcomes associated with this common condition. We emphasize the relevance of social determinants and their important intersection with atrial fibrillation treatment and outcomes. In closing, we identify gaps in the literature and propose future directions for the investigation of social determinants and atrial fibrillation.

Key points

  • Atrial fibrillation is the most common cardiac rhythm disorder, affecting nearly 60 million adults worldwide, and is associated with substantial morbidity and mortality.

  • Social determinants, such as race/ethnicity, financial resources, social support, rurality and residential environment, and health literacy, have crucial roles in the detection, evaluation, treatment and management of atrial fibrillation.

  • Despite their fundamental importance, to date, critical evaluation of the social determinants of health in relation to atrial fibrillation has been limited.

  • Collecting, studying and addressing social determinants of health provides an important opportunity to reduce the substantial social and economic burden of atrial fibrillation and its associated complications.

  • Important areas for future research include an examination of the intersectional influence of multiple social determinants of health on disadvantaged populations with atrial fibrillation and implementation strategies to eliminate health-care inequities.

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Fig. 1: Social determinants of atrial fibrillation.
Fig. 2: Determinants of racial and ethnic inequities across the atrial fibrillation care continuum.
Fig. 3: Racial/ethnic representation in clinical trials and observational studies of atrial fibrillation.
Fig. 4: Proposed framework for the role of social networks and social support in atrial fibrillation.
Fig. 5: Future directions for research on social determinants of atrial fibrillation.

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All the authors contributed to researching data for the article, discussing its content, writing the manuscript, and reviewing and editing it before submission.

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U.R.E. has received funding from the Department of Veterans Affairs VISN 4 Competitive Career Development Fund and Health Services Research and Development Service CDA-20-049. J.K. has received funding from the Marie Sklodowska-Curie Actions under the European Commission’s Horizon 2020 research and innovation programme (grant agreement no. 838259). E.J.B. is supported by grants 2R01 HL092577, 1R01 HL141434, 2U54HL120163, 1R01AG066010, 1R01AG066914, 2U54HL120163 and AHA 18SFRN34110082. J.W.M. is supported by grants R33HL144669 and R01HL143010. The other authors declare no competing interests.

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Essien, U.R., Kornej, J., Johnson, A.E. et al. Social determinants of atrial fibrillation. Nat Rev Cardiol 18, 763–773 (2021). https://doi.org/10.1038/s41569-021-00561-0

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