MP-3 - SOCIAL DETERMINANTS OF HEALTH AND ADVERSE OUTCOMES IN ARTIAL FIBRILLATION: A UK BIOBANK STUDY

Background: Beyond the risk of thromboembolic stroke, atrial fibrillation (AF) is substantially burdened with a higher incidence of cardiovascular mortality, even among patients treated with anticoagulants. The reasons behind are only partially understood. Social determinants of health (SDOH), strong independent predictors of major adverse cardiovascular events (MACE) in several cardiac diseases, may play a role; however, their impact on AF prognosis has been poorly investigated. We aimed to evaluate the associations between SDOH and MACE in patients with AF.

METHODS AND RESULTS: Data came from the UK Biobank. Participants with AF enrolled between 2006 to 2010 were included. Seventeen SDOH derived from three domains were identified: socio-economic status, psychosocial factors, and neighborhood and living environment. Cox proportional hazards were used to build models evaluating the associations of individual SDOH components with the risk of the outcome. Covariates including all variables of the CHA2DS2-VASc Score (Congestive heart failure, Hypertension, Age, Diabetes, prior stroke or transient ischemic attack, Vascular disease and Sex), use of antiplatelet or anticoagulation, smoking and body mass index. The primary outcome was a composite of MACE (including stroke, transient ischemic attack and arterial thromboembolic event, myocardial infarction and cardiovascular mortality) and all-cause mortality.

In the selected cohort, a total of 28,220 AF participants (mean age, 62.3±6.05 years; female sex 41%) were included. The composite outcome occurred in 6194 (21.9%) of participants over 10-year follow up. In the multivariate adjusted model , several SDOH were independently associated with an increased risk of the composite outcome, including living alone, social inactivity, lacking social support, lower income, not being employed, lower area level of education quality, unstable accommodation and higher level of material deprivation (Figure 1).


Conclusion: Deleterious SDOH were associated with higher risk of MACE and all-cause mortality in AF even after adjustments for CHA2DS2-VASc. These findings suggests that SDOH should be routinely collected to better stratify the risk of adverse outcomes in AF that are not adequately captured by the available clinically used prediction models.