An Evaluation of Social Determinants of Health in Atrial Fibrillation Research, From 2014 to 2024

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia. Social determinants of health (SDH) have been implicated in the development and outcomes of cardiovascular disease; however, they are typically underreported in randomized controlled trials (RCTs). It is unknown if this holds true in the study of AF.

Objectives

The purpose of this study was to investigate SDH reporting and analysis in AF RCTs.

Methods

A systematic review of AF RCTs in the PubMed database from 10 high-impact journals over the last decade was conducted. One reviewer assessed RCTs for characteristics associated with reporting and analyzing SDH, including demographic and socioeconomic characteristics. Descriptive statistics and logistic regressions were utilized to determine predictors of SDH characteristics.

Results

Of 323 RCTs, 240 were included. Nearly all reported age (99.6%) and gender (98.8%), while about 50% analyzed them (56.3% and 49.2%). Less than 33% reported or analyzed race and ethnicity and fewer than 10% addressed socioeconomic characteristics. Studies with increased participants and behavioral or pharmaceutical interventions had greater odds of analyzing age and gender. North American location and higher enrollment was associated with greater odds of reporting and analyzing race. Year of publication was associated with analyzing age and race.

Conclusions

While nearly all studies reported age and gender, a smaller fraction reported and analyzed race, ethnicity, and socioeconomic characteristics. Addressing these gaps is critical to evaluate the role of SDH in patient outcomes, especially in populations that are typically underrepresented in research. The current lack of standardization limits the generalizability of AF RCTs and subsequently developed clinical guidelines.