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. 2022 Jun 15;76(8):736-742.
doi: 10.1136/jech-2022-219190. Online ahead of print.

Income and outcomes of patients with incident atrial fibrillation

Fausto Biancari  1   2 , Konsta Teppo  3 , Jussi Jaakkola  3   4 , Olli Halminen  5 , Miika Linna  6   7 , Jari Haukka  8 , Jukka Putaala  9 , Pirjo Mustonen  3 , Janne Kinnunen  9 , Juha Hartikainen  10 , Aapo Aro  11 , Juhani Airaksinen  3 , Mika Lehto  11   12
Affiliations

Income and outcomes of patients with incident atrial fibrillation

Fausto Biancari et al. J Epidemiol Community Health. .

Abstract

Background: Socioeconomic disparities can be associated with adverse outcomes in patients with cardiovascular diseases. The impact of personal income on the outcomes of patients with atrial fibrillation (AF) is unclear.

Methods: Nationwide observational registry-based study on patients with incident AF in Finland during 2007-2018.

Results: 203 154 patients (mean age 73.0±13.5; females 49.0%) were diagnosed with incident AF during the study period. Overall, 16 272 (8.0%) patients experienced first-ever ischaemic stroke and 63 420 (31.2%) died (mean follow-up 4.3±3.3 years). After adjusting for confounding factors, low personal income was associated with increased risk of overall mortality in all age strata and the incidence of first-ever stroke in patients aged <65 years and 65-74 years, but not in those ≥75 years. The magnitude of this effect was greatest in patients aged <65 years. After propensity score matching of patients <65 years in the lowest and highest quintiles of maximum personal annual income, at 10 years, those in the highest income quintile (≥€54 000) had significantly lower risk of first-ever stroke (subdistribution HR 0.495, 95% CI 0.391 to 0.628) and overall mortality (HR 0.307, 95% CI 0.269 to 0.351) compared with patients in the lowest income quintile (≤€12 000).

Conclusions: Personal annual income has a significant impact on the incidence of first-ever ischaemic stroke and overall mortality among patients with incident AF, particularly among patients of working age. Low-income indicate the need for intervention strategies to improve outcomes of AF.

Trial registration number: NCT04645537.

Keywords: CARDIOVASCULAR DISEASES; COHORT STUDIES; Health inequalities.

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Conflict of interest statement

Competing interests: FB: none. KT: none. JJ: none. OH: none. JP reports personal fees from Boehringer-Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS-Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum, personal fees from Abbott, outside the submitted work. PM: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. JH: Consultant: Research Janssen R&D; Speaker: Bayer Finland. ML: Speaker: BMSPfizer-alliance, Bayer, Boehringer-Ingelheim. JH: Research grants: The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7. Advisory Board Member: BMS-Pfizer-alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. AA: Research grants: The Finnish Foundation for Cardiovascular Research, Sigrid Juselius Foundation; Speaker: Abbott, Bayer, Boehringer-Ingelheim. JA: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. ML: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim.

Figures

Figure 1
Figure 1
Competing risk and Kaplan-Meier’s estimates of first-ever ischaemic stroke and all-cause mortality in the lowest and highest quintiles of maximum personal annual income among propensity score matched patients with incident atrial fibrillation aged <65 years. HR, hazard ratio; SHR, subdistribution HR; CI, confidence interval.
See this image and copyright information in PMC

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