Evidence mapPaperPMID 35948379Full record

ArticleBMJ open2022

Outcome disparities in patients with atrial fibrillation based on insurance plan and educational attainment: a nationwide, multicenter and prospective cohort trial.

Sirin Apiyasawat, Tomon Thongsri, Kulyot Jongpiputvanich, Rungroj Krittayaphong, COOL-AF Investigators

Abstract readMulticenter Study
In one paragraph

Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Association Between Socioeconomic Status and Atrial Fibrillation: A Two-Sample Mendelian Randomization Study.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2026
    Article
  2. Article
  3. Disparities in the access to atrial fibrillation ablation in Denmark: who gets ablated, who neglected?Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024
    Article
  4. Social drivers in atrial fibrillation occurrence, screening, treatment, and outcomes: systematic-narrative hybrid review.European heart journal supplements : journal of the European Society of Cardiology · 2024
    Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Sirin ApiyasawatFaculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.ORCID 0000-0002-8396-0511
Tomon ThongsriBuddhachinaraj Hospital Medical School, Phitsanulok, Thailand.
Kulyot JongpiputvanichFaculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Rungroj KrittayaphongFaculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand rungroj.kri@mahidol.ac.th.ORCID 0000-0001-8684-2361
COOL-AF Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAtrial fibrillation (AF) is a complex disease. The management of AF requires continuous patient engagement and integrative healthcare.

objectivesTo explore the association between adverse AF-related clinical outcomes and the following two sociodemographic factors: educational attainment and insurance plan.

designA nationwide, prospective, multicenter, cohort trial.

settingNational registry of 3402 patients with non-valvular AF in Thailand.

participantsAll patients enrolled in the registry, except those with missing information on educational attainment or insurance plan. Finally, data from 3026 patients (mean age 67 years, SD 11.3; 59% male sex) were analysed. PRIMARY OUTCOMES: Incidences of all-cause mortality, ischaemic stroke and major bleeding during the 36-month follow-up period. Survival analysis was performed using restricted mean survival time (RMST) and adjusted for multiple covariates. The levels of the educational attainment were as follows: no formal education, elementary (grade 1-6), secondary (grade 7-12) and higher education (tertiary education).

resultsThe educational attainment of the majority of patients was elementary (N=1739, 57.4%). The predominant health insurance plans were the Civil Servant Medical Benefit Scheme (N=1397, 46.2%) and the Universal Coverage Scheme (N=1333, 44.1%). After 36 months of follow-up, 248 patients died (8.2%), 95 had ischaemic stroke (3.1%) and 136 had major bleeding (4.5%). Patients without formal education died 1.78 months earlier (adjusted RMST difference -1.78; 95% CI, -3.25 to -0.30; p=0.02) and developed ischaemic stroke 1.04 months sooner (adjusted RMST difference -1.04; 95% CI, -2.03 to -0.04; p=0.04) than those attained a level of higher education. There were no significant differences in RMSTs for all three clinical outcomes when considering the type of health insurance plan.

conclusionEducational attainment was independently associated with all-cause mortality and ischaemic stroke in patients with AF, but adverse clinical outcomes were not related to the types of health insurance in Thailand. TRIAL REGISTRATION NUMBER: Thai Clinical Trial Registration; Study ID: TCTR20160113002.

Indexed as

Atrial FibrillationBrain IschemiaInsuranceIschemic StrokeStrokeAgedAnticoagulantsFemaleHemorrhageHumansMaleProspective StudiesRegistriesRisk FactorsAnticoagulantsAdult cardiologyHealth policyPUBLIC HEALTHThromboembolism

Identifiers

PMID35948379
PMCPMC9379473

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.