Abstract
Importance: Only modest attention has been paid to the contributions of social determinants of health to atrial fibrillation (AF) risk factors, diagnosis, symptoms, management, and outcomes. The diagnosis of AF provides unique challenges exacerbated by the arrhythmia's often paroxysmal nature and individuals' disparate access to health care and technologies that facilitate detection. Social determinants of health affect access to care and management decisions for AF, increasing the likelihood of adverse outcomes among individuals who experience systemic disadvantages. Developing effective approaches to address modifiable social determinants of health requires research to eliminate the substantive inequities in health care delivery and outcomes in AF. Observations: The National Heart, Lung, and Blood Institute convened an expert panel to identify major knowledge gaps and research opportunities in the field of social determinants of AF. The workshop addressed the following social determinants: (1) socioeconomic status and access to care; (2) health literacy; (3) race, ethnicity, and racism; (4) sex and gender; (5) shared decision-making in systemically disadvantaged populations; and (6) place, including rurality, neighborhood, and community. Many individuals with AF have multiple adverse social determinants, which may cluster in the individual and in systemically disadvantaged places (eg, rural locations, urban neighborhoods). Cumulative disadvantages may accumulate over the life course and contribute to inequities in the diagnosis, management, and outcomes in AF. Conclusions and Relevance: Workshop participants identified multiple critical research questions and approaches to catalyze social determinants of health research that address the distinctive aspects of AF. The long-term aspiration of this work is to eradicate the substantive inequities in AF diagnosis, management, and outcomes across populations..
| Original language | English (US) |
|---|---|
| Pages (from-to) | 182-191 |
| Number of pages | 10 |
| Journal | JAMA cardiology |
| Volume | 8 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 8 2023 |
Funding
Funding/Support: Dr Benjamin receives research funding from National Heart, Lung, and Blood Institute grants R01HL128914, 2R01HL092577, and R01HL141434 01A1; National Institute of Aging grant R01AG066010; and American Heart Association grant 18SFRN34110082. Dr Thomas reports funding from Patient Centered Outcomes Research Institute grant 1503-29746 and US National Institutes of Health grants 5UL1-TR001117-03, 1R01-MD013493-01, 1R01-MD011606-03, 5U54MD012530-03, and 5R25HL135304-05. Dr Go receives research funding from National Heart, Lung, and Blood Institute grant R01HL142834 and National Institute of Diabetes and Digestive and Kidney Diseases grant R01DK103612. Dr Albert receives research funding from National Heart, Lung, and Blood Institute grant R01HL116690. Dr Essien receives research funding from Veterans Health Administration grant IK2HX003176. Dr Hernandez receives research funding from National Heart, Lung, and Blood Institute grants R01HL157051 and K01HL142847. Dr Kershaw receives research funding from National Institute of Aging grants 5R01AG67557, 5R01AG062180, and 1R21AG069435 and American Heart Association grant 22HERNPMI985236. Dr Levy receives research funding from National Heart, Lung, and Blood Institute grants R01 HL153607, R01 HL163377, R01 HL146059, R01 HL127215, and T32 HL120822; National Institute of Minority Health and Health Disparities grant P50 MD017351; and the American Heart Association Health Equity Research Network . Dr Magnani receives research funding from National Heart, Lung, and Blood Institute grants R01HL143010, R33HL144669, and K24HL160527. Dr Rodriguez receives funding from the National Heart, Lung, and Blood Institute and the American Heart Association . Dr Alonso receives funding from National Heart, Lung, and Blood Institute grants K24HL148521 and R01HL137338 and American Heart Association grant 16EIA26410001. Dr Kershaw receives research funding from National Institute on Aging grants R01AG067557, R01AG062180, and R21AG069435. Dr Chamberlain receives funding from National Institute on Aging grants R21AG62580 and R21AG64804 and Patient Centered Outcomes Research Institute grant RI-CRN-2020-009.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
