Arrhythmias & electrophysiology
Lower socioeconomic status is associated with lower quality of care of atrial fibrillation despite comprehensive no-cost access to medical care in Australia
Authors' conclusion
The lowest SES groups compared with the highest were associated with reduced access to cardioversion and ablation after index attendance, along with more frequent EMS re-presentations for AF and higher mortality within 30 days and long-term follow-up.
Study context
- Population
- Adults attended by emergency medical services (EMS) for atrial fibrillation (AF) across Victoria, Australia (January 2015 to June 2019), stratified into socioeconomic status (SES) quintiles using census-based postcode indicesPrimary analysis (median age 76, Q1-Q3 67–84, 43% male)
- Participants
- 14,987 adults
- Exposure
- lowest SES group compared with the highest SES quintile
Methodological detailsconsecutive adults
- Consecutive adults
Main finding
As reported in the abstract
Outpatient cardioversion, ablation, EMS re-presentations and mortality (time-to-event analysis)
- Gradient of lower rates of outpatient cardioversion and ablation and increased EMS re-presentations and mortality among lower SES groups
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | P value | |
|---|---|---|---|
| Cardioversions · multivariable analysis | aHR 0.73 (CI 0.61–0.86) | P < 0.001 | |
| Ablations · multivariable analysis | aHR 0.48 (CI 0.39–0.60) | P < 0.001 | |
| EMS re-presentation for AF · within 30 days | adjusted odds ratio 1.61 (CI 1.19–2.17) | P = 0.002 | |
| EMS re-presentation for AF · median of 2.1-year follow-up | aHR 1.18 (CI 1.03–1.36) | P = 0.019 | |
| Mortality · 30 days | adjusted odds ratio 1.68 (CI 1.31–2.15) | P < 0.001 | |
| Mortality · median of 2.1-year follow-up | aHR 1.42 (CI 1.28–1.58) | P < 0.001 | |
| 0.20.5125Ratio (log scale) |
EMS re-presentation (competing-risk model, death as competing event)
- Re-presentation effect estimates remained directionally similar but attenuated and no longer statistically significant
- Sensitivity analysis
Original publication
Lower socioeconomic status is associated with lower quality of care of atrial fibrillation despite comprehensive no-cost access to medical care in Australia. Heart Rhythm. Published 5 May 2026. doi:10.
Summarised from the published abstract; every number is checked against it