Association between socio-economic status and incident atrial fibrillation

Background: Low socio-economic status is associated with cardiovascular diseases, and an association with atrial fibrillation (AF) could guide screening. We investigated if indices of disadvantage (IAD), education/occupation (IEO) and economic resources (IER) were associated with incident AF, independent of risk factors and cardiac function.

Methods: We studied community-based participants aged ≥ 65 years with AF risk factors (n = 379, age 70 ± 4 years, 45% men). The CHARGE-AF score (a well validated AF risk score) was used to assess 5-year risk of developing AF. Participants also had baseline echocardiograms. IAD, IEO and IER were obtained from the 2011 Socio-Economic Indexes for Areas (SEIFA) score, in which higher decile ranks indicate more advantaged areas. Patients were followed up for incident AF(median 21 (range 5-31) months), with AF diagnosed by clinical review including 12 lead ECG, as well as single lead portable ECG monitoring used to record 60 second ECG tracings five times/day for one week. Cox proportional hazards models were used to assess the association between socio-economic status and incident AF.

Results: Subjects with AF (n = 50, 13%) were more likely to be male (64% vs.42%, p = 0.003) and had higher CHARGE-AF score (median 7.1% (5.2-12.8%) vs. 5.3% (3.3-8.6%), p < 0.001). Areas with lower socio-economic status (IAD and IEO) had a higher risk of incident AF independent of LV function and CHARGE-AF score (HR for IAD 1.16, 95% C.I 1.05-1.29, p = 0.005 and HR for IEO 1.18, 95% C.I 1.07-1.30, p = 0.001).

Conclusion: Regional socio-economic status is associated with risk of incident AF, independent of LV function and clinical risk. This association might permit better regional targeting of prevention.