Social drivers in atrial fibrillation occurrence, screening, treatment, and outcomes: systematic-narrative hybrid review

Lars Frost*, Søren Paaske Johnsen, Emelia J. Benjamin, Ludovic Trinquart, Nicklas Vinter

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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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.

Original languageEnglish
JournalEuropean Heart Journal Supplements
Volume26
Issue numberSuppl 4
Pages (from-to)iv50-iv60
Number of pages11
ISSN1520-765X
DOIs
Publication statusPublished - Jul 2024

Bibliographical note

© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.

Keywords

  • Atrial fibrillation
  • Outcome
  • Screening
  • Social determinants of health
  • Socioeconomic Factors
  • Treatment

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