Persistent inequity in survival after atrial fibrillation

Atrial fibrillation, also known as AF or Afib, is one of the most common cardiovascular diseases. In fact, one in three individuals can expect to be diagnosed by the condition, which increases the risk of serious complications such as heart failure and stroke.

Despite significant advances in the treatment of atrial fibrillation, a new Danish study from Aalborg University shows that social inequities in survival have remained virtually unchanged over the past 20 years.

The article has just been published in the internationally recognized journal The Lancet Public Health in collaboration with the University of Liverpool, Tufts Medical Center in Boston, and Boston University.

The study is based on nationwide Danish registry data from more than 380,000 patients diagnosed with atrial fibrillation between 2000 and 2022 and documents inequities in income, education, and social relationships still have a major impact on life expectancy after diagnosis.

Individuals diagnosed with AF who have a low income live on average 2.5 years shorter than those with high income. Low educational level results in a loss of 1.8 years of life, while living alone costs about 1.6 years.

“Advances in the management and treatment of atrial fibrillation have improved survival for everyone but have not closed the gap between social groups. This is clearly a problem in a tax-funded universal healthcare system with formally equal access to treatment for all - especially when we know how much prevention can actually matter,” says the study’s lead author, Nicklas Vinter, MD, PhD, and postdoctoral researcher at the Danish Center for Health Services Research at Aalborg University.

He also points out that the global incidence of atrial fibrillation is rising, making the results relevant far beyond Denmark’s borders.

"This is clearly a problem in a tax-funded universal healthcare system with formally equal access to treatment for all - especially when we know how much prevention can actually matter" 

Nicklas Vinter, MD, PhD, and postdoctoral researcher, Danish Center for Health Services Research, Aalborg University.

Social and structural barriers must be addressed

According to Nicklas Vinter, the causes of inequity are not only linked to medical treatment but also to social and behavioral factors. For some patients, treatment guidelines can be difficult to understand and translate into concrete action, and many lack a social network that can provide practical support in everyday life.

Therefore, the researchers behind the study propose a new tool, FAIR-PRO-AF, which can help decision-makers and researchers across sectors systematically reduce inequity and create continuous improvements.

The tool is designed as a circular work cycle: first, the social factors associated with survival are mapped. Next, the barriers that hinder equity in access, quality, and effectiveness of treatment are identified. In the third step, concrete initiatives are prioritized and implemented, and finally, the effect is evaluated before the cycle moves on to the next round.

“The social and structural barriers that limit patients’ access to knowledge, resources, and support must be addressed if we want to improve prognoses for all. This requires a broader effort where the healthcare system collaborates with social and political actors,” says Nicklas Vinter.