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J Am Heart Assoc. 2022;11(24):e027192.

Impact of Socioeconomic Status on Emergency Department Visits in Patients With Atrial Fibrillation: A Nationwide Population-Based Cohort Study.

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제1저자 최정민, 이소령 · 교신저자 최의근

소속 (5)
  1. Department of Hospital Medicine Center Seoul National University Hospital Seoul Republic of Korea.
  2. Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea.
  3. Department of Statistics and Actuarial Science Soongsil University Seoul Republic of Korea.
  4. Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool UK.
  5. Department of Clinical Medicine Aalborg University Aalborg Denmark.

Abstract

Background Socioeconomic status (SES) differences could influence management and clinical outcomes in patients with atrial fibrillation (AF), reflecting health inequalities. The authors aimed to investigate emergency department (ED) visits in patients with AF according to SES level. Methods and Results The authors performed a cross-sectional analysis of ED visits in patients with nonvalvular AF using the Korean National Health Insurance Service database in 2016. The patients were divided into health premium quartiles and medical aid groups, with quartile 4 the highest SES and medical aid the lowest SES. Among patients with AF, patients who had ≥1 ED visits in 2016 were identified. The prevalence and cause of ED visits, 30- and 90-day mortality, and rehospitalization risk after ED visits were evaluated. Among the total 371 017 AF patients, 99 306 patients visited the ED in 2016. The medical aid group showed the highest ED visit rate (n=11 833, 38.0%), and patients with the highest quartile of SES (quartile 4 group) showed the lowest ED visit rate (n=38 037, 30.0%). The most common cause of ED visits was cerebral infarction in all groups. The 30- and 90-day mortality rates and rehospitalization risk after ED visits was higher in groups with lower SES. Conclusions Patients with AF and with lower SES had a higher risk of ED visit rate, higher 30- and 90-day mortality rates, and rehospitalization risk after ED visit. Tailored AF management according to different SES levels in patients with AF is needed to improve clinical outcomes.

Keywords

atrial fibrillationemergency departmentsocioeconomic status

Figures

Figure 1
Figure 1 Number of patients with AF who visited the ED and prevalence of ED visits by SES. *Groups divided into medical aid quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4) in the order of low income: Q4 the highest SES and medical aid the lowest SES. AF indicates atrial fibrillation; ED, emergency department; and SES, socioeconomic status.
Figure 2
Figure 2 Patient distribution by the number of ED visits according to SES. *Groups divided into medical aid quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4) in the order of low income: Q4 the highest SES and medical aid the lowest SES. ED indicates emergency department; and SES, socioeconomic status.
Figure 3
Figure 3 Common causes of ED visits in patients with AF. *Groups divided into medical aid quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4) in the order of low income: Q4 the highest SES and medical aid the lowest SES. AF indicates atrial fibrillation; AMI, acute myocardial infarction; CKD, chronic kidney disease; ED, emergency department; and SES, socioeconomic status.
Figure 4
Figure 4 Trends of incidence of ED visit from AF‐related complication. *Groups divided into medical aid quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4) in the order of low income: Q4 the highest SES and medical aid the lowest SES. AF indicates atrial fibrillation; ED, emergency department; GI, gastrointestinal; HF, heart failure; ICH, intracranial hemorrhage; MI, myocardial infarction; NOAC, nonvitamin K antagonist oral anticoagulants; OAC, oral anticoagulant; and SES, socioeconomic status.
Figure 5
Figure 5 Thirty‐day and 90‐day mortality and hospitalization after ED visit by SES. *Groups divided into medical aid, quartile 1, quartile 2, quartile 3, and quartile 4 (Q4) in the order of low income: Q4 the highest SES and medical aid the lowest SES. ED indicates emergency department; and SES, socioeconomic status.

그림 출처: PubMed Central 공개 논문 (PMC9798818)

그 밖의 정보
출판 형태
Journal Article, Research Support, Non-U.S. Gov't
저널
Journal of the American Heart Association · eISSN 2047-9980
전자 출판
2022-12-14
MeSH
Humans · Atrial Fibrillation* / epidemiology / therapy · Cohort Studies · Cross-Sectional Studies · Social Class · Emergency Service, Hospital · Retrospective Studies
연구비
NIEHS NIH HHS 27302C0028
참고문헌
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