Socioeconomic differences in outcomes after hospital admission for atrial fibrillation or flutter

Louise Hagengaard, Mikkel Porsborg Andersen, Christoffer Polcwiartek, Jacob Mosgaard Larsen, Mogens Lytken Larsen, Regitze Kuhr Skals, Steen Møller Hansen, Sam Riahi, Gunnar Gislason, Christian Torp-Pedersen, Peter Søgaard, Kristian Hay Kragholm

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

AIMS: To examine socioeconomic differences in care and outcomes in a one-year period beginning 30 days after hospital discharge for first-time AF hospitalization.

METHODS AND RESULTS: This nationwide register-based follow-up cohort study investigated AF 30-day discharge survivors in Denmark during 2005-2014 and examined associations between patient's socioeconomic status (SES) and selected outcomes during a 1-year follow-up period beginning 30 days post-discharge after first-time hospitalization for AF. Patient SES was defined in four groups (lowest, second lowest, second highest and highest) according to each patient's equivalized income. SES of the included 150,544 patients was: 27.7% lowest (n = 41,648), 28.1% second lowest (n = 42,321), 23.7% second highest (n = 35,656) and 20.5% highest (n = 30,919). Patients of lowest SES were older and more often women. Within 1-year follow-up, patients of lowest SES were less often re-hospitalized or seen in outpatient clinics due to AF, or treated with cardioversion or ablation, and were slightly more often diagnosed with stroke and heart failure and significantly more likely to die (16.1% vs. 14.9%, 11.3% and 8.1%). Hazard ratios for all-cause mortality were 0.64 (95% CI 0.61-0.68) for highest vs. lowest SES, adjusted for CHA2DS2-VASc-score, COPD, rate- and rhythm-controlling drugs and cohabitation status.

CONCLUSION: In 30-day survivors of first-time hospitalization due to AF, lowest SES is associated with increased 1-year all-cause and cardiovascular mortality and fewer cardioversions, ablations, readmissions and outpatient contacts due to AF. Our findings indicate a need for socially differentiated rehabilitation following hospital discharge for first-time AF.

Original languageEnglish
JournalEuropean heart journal. Quality of care & clinical outcomes
Volume7
Issue number3
Pages (from-to)295–303
Number of pages9
ISSN2058-1742
DOIs
Publication statusE-pub ahead of print - 27 Sep 2019

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