Arrhythmias & electrophysiologyCohort study
Lower socioeconomic status is associated with lower quality of care of atrial fibrillation despite comprehensive no-cost access to medical care in Australia
- population-based cohort study
- consecutive adults
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
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:10.1016/j.hrthm.2026.04.052
Summarised from the published abstract; every number is checked against it