Lower socioeconomic status is associated with lower quality of care of atrial fibrillation despite comprehensive no-cost access to medical care in Australia.
Heart rhythm · 2026-05-05 · Registry study
Abstract
BACKGROUND: Socioeconomic status (SES) is an established risk factor for poor cardiovascular outcomes, with atrial fibrillation (AF) a major contributor to cardiovascular morbidity and mortality. OBJECTIVE: This study aimed to examine associations among SES, clinical outcomes, and access to guideline-directed therapies in patients attended by emergency medical services (EMS) with a prehospital AF diagnosis within a universal health care setting METHODS: We conducted a population-based cohort study of consecutive adults attended by EMS for AF across Victoria, Australia (January 2015 to June 2019). Patients were stratified into SES quintiles using census-based postcode indices. RESULTS: Primary analysis included 14,987 patients (median age 76; Q1-Q3 67-84; 43% male). Time-to-event analysis demonstrated a gradient of lower rates of outpatient cardioversion and ablation and increased EMS re-presentations and mortality among lower SES groups. On multivariable analysis compared with the highest SES quintile, the lowest SES group was associated with reduced cardioversions (adjusted hazard ratio [aHR] 0.73 [0.61-0.86]; P < .001) and ablations (aHR 0.48 [0.39-0.60]; P < .001) and a higher risk of EMS re-presentation for AF within 30 days (adjusted odds ratio 1.61 [1.19-2.17]; P = .002) and over a median of 2.1-year follow-up (aHR 1.18 [1.03-1.36]; P = .019). Mortality was also higher at 30 days (adjusted odds ratio 1.68 [1.31-2.15]; P < .001) and over a median of 2.1-year follow-up (aHR 1.42 [1.28-1.58]; P < .001) than the highest SES group. In a competing-risk model treating death as a competing event, re-presentation effect estimates remained directionally similar but attenuated and no longer statistically significant. CONCLUSION: The lowest SES groups compared with the highest were associated with reduced access to cardioversion and ablation after index attendance, along with more frequent EMS re-presentations for AF and higher mortality within 30 days and long-term follow-up.