Transforming Atrial Fibrillation Research to Integrate Social Determinants of Health A National Heart, Lung, and Blood Institute Workshop Report

被引：25

作者：

Benjamin, Emelia J. ^{[1
,2
]}

Thomas, Kevin L. ^{[3
]}

Go, Alan S. ^{[4
,5
,6
,7
]}

Desvigne-Nickens, Patrice ^{[8
]}

Albert, Christine M. ^{[9
]}

Alonso, Alvaro ^{[10
]}

Chamberlain, Alanna M. ^{[11
,12
]}

Essien, Utibe R. ^{[13
]}

Hernandez, Inmaculada ^{[14
]}

Hills, Mellanie True ^{[15
]}

Kershaw, Kiarri N. ^{[16
]}

Levy, Phillip D. ^{[17
,18
]}

Magnani, Jared W. ^{[13
]}

Matlock, Daniel D. ^{[19
,20
]}

O'Brien, Emily C. ^{[21
]}

Rodriguez, Carlos J. ^{[22
,23
]}

Russo, Andrea M.

Soliman, Elsayed Z.

Cooper, Lawton S. ^{[8
]}

Al-Khatib, Sana M. ^{[3
]}

机构：

[1] Boston Univ Chobanian, Avedisian Sch Med, Dept Med, Cardiovasc Med, Boston, MA USA

[2] Boston Univ, Dept Epidemiol, Sch Publ Hlth, Boston, MA USA

[3] Duke Univ, Duke Clin Res Inst, Div Cardiol, Med Ctr, Durham, NC USA

[4] Kaiser Permanente Northern Calif, Div Res, Oakland, ON, Canada

[5] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA USA

[6] Stanford Univ, Dept Med, Stanford, CA USA

[7] Univ Calif San Francisco, Dept Med, San Francisco, CA USA

[8] NHLBI, Div Cardiovasc Sci, NIH, Bethesda, MD USA

[9] Cedars Sinai Med Ctr, Smidt Heart Inst, Dept Cardiol, Los Angeles, CA USA

[10] Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA USA

[11] Mayo Clin, Dept Quantitat Hlth Sci, Sect Cardiovasc Med, Rochester, MN USA

[12] Mayo Clin, Dept Cardiovasc Med, Dept Med, Cardiovasc Med, Rochester, MN USA

[13] Univ Pittsburgh, Dept Med, Pittsburgh, PA USA

[14] Univ Calif San Diego, Skaggs Sch Pharm & Pharmaceut Sci, San Diego, CA USA

[15] Amer Fdn Womens Hlth, StopAfib org, Decatur, TX USA

[16] Northwestern Univ, Dept Prevent Med, Feinberg Sch Med, Chicago, IL USA

[17] Wayne State Univ, Dept Emergency Med, Detroit, MI USA

[18] Wayne State Univ, Integrated Biosci Ctr, Detroit, MI USA

[19] Univ Colorado, Div Geriatr, Anschutz Med Campus, Aurora, CO USA

[20] VA Eastern Colorado Geriatr Res Educ & Clin Ctr, Denver, CO USA

[21] Duke Univ, Dept Populat Hlth Sci, Sch Med, Durham, NC USA

[22] Albert Einstein Coll Med, Div Cardiovasc Med, New York, NY USA

[23] Albert Einstein Coll Med, Dept Epidemiol & Populat Hlth, New York, NY USA

来源：

JAMA CARDIOLOGY | 2023年 / 8卷 / 02期

基金：

美国国家卫生研究院;

关键词：

SHARED DECISION-MAKING; SEX-RELATED DIFFERENCES; CARDIOVASCULAR-DISEASE; MORTALITY; RISK; RACE; CARE; REPRESENTATION; DISADVANTAGE; ASSOCIATION;

D O I：

10.1001/jamacardio.2022.4091

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

IMPORTANCE Only modest attention has been paid to the contributions of social determinants of health to atrial fibrillation (AF) risk factors, diagnosis, symptoms, management, and outcomes. The diagnosis of AF provides unique challenges exacerbated by the arrhythmia's often paroxysmal nature and individuals' disparate access to health care and technologies that facilitate detection. Social determinants of health affect access to care and management decisions for AF, increasing the likelihood of adverse outcomes among individuals who experience systemic disadvantages. Developing effective approaches to address modifiable social determinants of health requires research to eliminate the substantive inequities in health care delivery and outcomes in AF.OBSERVATIONS The National Heart, Lung, and Blood Institute convened an expert panel to identify major knowledge gaps and research opportunities in the field of social determinants of AF. The workshop addressed the following social determinants: (1) socioeconomic status and access to care; (2) health literacy; (3) race, ethnicity, and racism; (4) sex and gender; (5) shared decision-making in systemically disadvantaged populations; and (6) place, including rurality, neighborhood, and community. Many individuals with AF have multiple adverse social determinants, which may cluster in the individual and in systemically disadvantaged places (eg, rural locations, urban neighborhoods). Cumulative disadvantages may accumulate over the life course and contribute to inequities in the diagnosis, management, and outcomes in AF.CONCLUSIONS AND RELEVANCE Workshop participants identified multiple critical research questions and approaches to catalyze social determinants of health research that address the distinctive aspects of AF. The long-term aspiration of this work is to eradicate the substantive inequities in AF diagnosis, management, and outcomes across populations.

引用

页码：182 / 191

页数：10

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