Socioeconomic deprivation and 1 year clinical outcomes after cryablation for atrial fibrillation
Authors: Lau Y , Cimpeanu O , Marshall GE , Padfield GJ , Wright GA , Connelly DT 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
Socioeconomic deprivation has previously been demonstrated to result in worse heart failure and myocardial infarction outcomes. Published studies shown lower socioeconomic group to associate with higher prevalence of atrial fibrillation (AF), increased mortality and morbidity. However, the impact of socioeconomic deprivation on clinical outcomes post AF cryoablation has yet to be investigated.

AIM
To assess the impact of socioeconomic deprivation (as categorised by Scottish Index of Multiple Deprivation, SIMD) on the medical management and clinical outcomes of patients with AF treated by cryoablation.

METHODS
A retrospective study of paroxysmal or persistent AF patients after cryoablation. The parameters included basic demographics, weight, past medical history (inclusive of hypertension, heart failure, diabetes, stroke or transient ischaemic attacks, prior myocardial infarction, obstructive sleep apnoea) and alcohol misuse. Medical treatment post AF ablation (Beta blocker, non-dihydropyridine calcium channel blocker, flecainide, amiodarone, dronaderone, sotolol, anticoagulant use) were also recorded.
Individual’s socioeconomic deprivation index, as described SIMD was also recorded (1 – most deprived and 10 – least deprived), and accordingly placed into quintile (SIMD 1-2,3-4,5-6,7-8, 9-10). Follow-up for 12 months.
Clinical outcome assessed was rate of readmission for symptomatic documented AF, rate of heart failure admission, stroke, bleeding diathesis and all-cause mortality.

RESULTS
312 patients were identified: 65 from the lowest quintile (SIMD 1-2), 57 from SIMD 3-4, 54 from SIMD 5-6, 52 from SIMD 7-8, and 84 from the highest quintile (SIMD 9-10). No statistical difference exists between age, gender or weight. Lowest socioeconomic quintile has higher incidence of heart failure (p =0.018) but other past medical history was no different. No difference in incidence of alcohol misuse.
Prescription rate/rhythm control agents and anticoagulant use post ablation was not statistically different between all groups.
12 months follow-up demonstrated readmission for symptomatic documented AF was statistically higher among patients of lowest socioeconomic quintile (Keplan Meier plot, p = 0.001). Stepwise multiple regression analysis also confirmed multiple socioeconomic deprivation as an independent predictor for more adverse clinical outcome (p = 0.02).
Risk of readmission for AF in patients from the wealthiest socioeconomic group is almost a quarter as compared to those of most deprived social group (Odd-ratio 0.273 (95% CI 0.122 – 0.607)).
Other clinical outcomes including risk of admissions for heart failure, stroke, bleeding diathesis and all-cause mortality was not statistically different across all groups.

Summary
After cryoablation for AF, patients from the lower socioeconomic group are still more likely to experience readmission for symptomatic AF at 12-month, despite similar post-procedure pharmaceutical agents utilised.