Association of atrial fibrillation symptom burden with social determinants of health
Authors
Anish S. Shah, Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City, Utah, USA; Department of Medicine, Division of Cardiology, University of Illinois Chicago, Chicago, Illinois, USA; Department of Medicine, Division of Academic Internal Medicine, University of Illinois Chicago, Chicago, Illinois, USA; Department of Medicine, Jesse Brown Veterans Administration Medical Center, Chicago, Illinois, USA. Electronic address: anish.shah@hsc.utah.edu.
Alvaro Alonso, Advocate Health - Midwest
Jaleel Sweis, Department of Medicine, Division of Cardiology, University of Illinois Chicago, Chicago, Illinois, USA.
Sorin Griza, Department of Medicine, Jesse Brown Veterans Administration Medical Center, Chicago, Illinois, USA.
Yining Chen, Department of Medicine, Division of Cardiology, University of Illinois Chicago, Chicago, Illinois, USA.
Miles Barney, Department of Medicine, Division of Cardiology, University of Illinois Chicago, Chicago, Illinois, USA.
Annette Diaz, Department of Medicine, Division of Cardiology, University of Illinois Chicago, Chicago, Illinois, USA.
Bahaa Al-Azzam, Department of Medicine, Division of Cardiology, University of Illinois Chicago, Chicago, Illinois, USA.
Mary R. Ziccardi, Department of Medicine, Division of Cardiology, University of Illinois Chicago, Chicago, Illinois, USA.
Aylin Ornelas-Loredo, Department of Medicine, Division of Cardiology, University of Illinois Chicago, Chicago, Illinois, USA.
Faisal A. Darbar, Department of Medicine, Division of Cardiology, University of Illinois Chicago, Chicago, Illinois, USA.
Amit J. Shah, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; Department of Medicine, Atlanta VA Medical Center, Decatur, Georgia, USA.
Emelia J. Benjamin, Department of Medicine, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA.
Dawood Darbar, Department of Medicine, Division of Cardiology, University of Illinois Chicago, Chicago, Illinois, USA; Department of Medicine, Jesse Brown Veterans Administration Medical Center, Chicago, Illinois, USA. Electronic address: darbar@uic.edu.
Recommended Citation
Shah AS, Alonso A, Sweis J, et al. Association of Atrial Fibrillation Symptom Burden With Social Determinants of Health. JACC Adv. Published online November 6, 2025. doi:10.1016/j.jacadv.2025.102302
Abstract
Background: Social determinants of health (SDoH) may influence the clinical presentation, management, and outcomes related to atrial fibrillation (AF).
Objectives: This study aims to examine the associations of SDoH with trajectories in AF symptom burden in participants undergoing AF treatment.
Methods: The authors designed a prospective, observational cohort study at an academic medical center in a large U.S. metropolitan city serving predominantly low-income and underinsured populations. Participants were those referred with an initial diagnosis of paroxysmal or persistent AF. Adverse SDoH, including NDI (National Deprivation Index), insurance status, language, and marital status, as well as proxies for structural and systemic biases through race, ethnicity, and sex were assessed. Participants received standard care with study-specific follow-up at 1 year. The outcome was scores from the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire (higher scores representing better quality of life).
Results: Of 515 participants who had follow-up assessments; 41% were non-Hispanic Black, 40% were non-Hispanic White, and 18% were Hispanic/Latinx. The mean AFEQT score at baseline was 73 (of 100) and at follow-up was 80 (SD: 19). Participants living in higher levels of NDI experienced 6.4 (95% CI: 1.9-11.0) point smaller increase in AFEQT scores compared to those in lower levels of NDI, and non-Hispanic Blacks experienced a 4.6 (95% CI: 1.1-8.0) point smaller increase compared to non-Hispanic Whites. There were 61 admissions for decompensated heart failure, 53 ischemic strokes, and 47 all-cause mortality events.
Conclusions: After adjusting for clinical factors, adverse SDoH associate with blunted improvements in AF symptom burden after 1 year of clinical management.
Affiliations
Advocate Christ Medical Center