Transforming Atrial Fibrillation Research to Integrate Social Determinants of Health

Abstract

ImportanceOnly modest attention has been paid to the contributions of social determinants of health to atrial fibrillation (AF) risk factors, diagnosis, symptoms, management, and outcomes. The diagnosis of AF provides unique challenges exacerbated by the arrhythmia’s often paroxysmal nature and individuals’ disparate access to health care and technologies that facilitate detection. Social determinants of health affect access to care and management decisions for AF, increasing the likelihood of adverse outcomes among individuals who experience systemic disadvantages. Developing effective approaches to address modifiable social determinants of health requires research to eliminate the substantive inequities in health care delivery and outcomes in AF.ObservationsThe National Heart, Lung, and Blood Institute convened an expert panel to identify major knowledge gaps and research opportunities in the field of social determinants of AF. The workshop addressed the following social determinants: (1) socioeconomic status and access to care; (2) health literacy; (3) race, ethnicity, and racism; (4) sex and gender; (5) shared decision-making in systemically disadvantaged populations; and (6) place, including rurality, neighborhood, and community. Many individuals with AF have multiple adverse social determinants, which may cluster in the individual and in systemically disadvantaged places (eg, rural locations, urban neighborhoods). Cumulative disadvantages may accumulate over the life course and contribute to inequities in the diagnosis, management, and outcomes in AF.Conclusions and RelevanceWorkshop participants identified multiple critical research questions and approaches to catalyze social determinants of health research that address the distinctive aspects of AF. The long-term aspiration of this work is to eradicate the substantive inequities in AF diagnosis, management, and outcomes across populations.

An explainable AI approach for discovering social determinants of health and risk interactions for stroke in patients with atrial fibrillation

“…A recent NIH Workshop Report emphasized the need for computational approaches that include social determinants of health to eliminate the inequities in healthcare delivery and outcomes in AF. 2 Here we demonstrate that explainable AI can fulfill this need.…”

Risk Factors for the Development of New-Onset Persistent Atrial Fibrillation: Subanalysis of the VITAL Study

“…33 Studies examining more prevalent forms of AF have had mixed results, 34,35 possibly due to lower use of cardioversion and catheter ablation in women over time. [34][35][36] Cardiac structural differences between the sexes may account for some of the greater propensity for men to present with persistent AF than women. Women generally have smaller LA, 37 which would lower the risk for persistent AF; however, in our data, men with AF remained more likely to present with persistent AF after controlling LA size, as well as other measures of structural heart disease, including LVEF.…”

Environmental Exposome and Atrial Fibrillation: Emerging Evidence and Future Directions

“…Finally, a glaring issue within exposome and AF research is the alarming deficiency of data involving key demographic groups. 6 This shortfall in data is particularly concerning for individuals from underrepresented racial and ethnic groups, who may exhibit unique risk factors or disease trajectories, which are currently underexplored. Additionally, further research is needed on people with high-risk occupations, such as those with high noise or chemical exposures.…”

“…[6][7][8] Adverse social determinants of health have been consistently associated with incident AF, AF treatment, and outcomes. [6][7][8][9][10] The social environment is the broader physical, social, and cultural context in which people live that influences human behavior, relationships, development, and quality of life. It includes factors like institutions, culture, technology, demographics, socioeconomics, geography, politics, and media, and overlaps with natural and built environments.…”