Income and outcomes of patients with incident atrial fibrillation

Fausto Biancari, Konsta Teppo, Jussi Jaakkola, Olli Halminen, Miika Linna, Jari Haukka, Jukka Putaala, Pirjo Mustonen, Janne Kinnunen, Juha Hartikainen, Aapo Aro, Juhani Airaksinen, Mika Lehto, Fausto Biancari, Konsta Teppo, Jussi Jaakkola, Olli Halminen, Miika Linna, Jari Haukka, Jukka Putaala, Pirjo Mustonen, Janne Kinnunen, Juha Hartikainen, Aapo Aro, Juhani Airaksinen, Mika Lehto

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.

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.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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

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