Atrial fibrillation (AF) is the most common arrhythmia. The expected rate is more than 12 million Americans by 2030. AF elevates the risk of myocardial infarction, stroke, cardiovascular disease, and decreased quality of life. Modifiable risk factors like sedentary lifestyle, inflammation, obesity, hypertension, and type 2 diabetes mellitus are associated with food availability. Social determinants, such as food deserts and food insecurity, increase these risks by reducing access to nutritious foods, which is influenced by income, transportation, and healthcare access. About 19 million Americans live in food deserts with an increased rate of food insecurity, with a significant rate of food insecurity in cities like New Orleans. Food deserts are linked with heart failure and cardiovascular disease; their effect on AF is not clear.
This study aimed to investigate the disease burden, demographics, and results of AF patients who consume food deserts and focuses on risks of hospitalization, ischemic stroke, and mortality.
This retrospective study analyzed AF patients treated at Tulane Medical Center (2010 to 2019) by using data from the Research Action for Health Network (REACHnet). Patients were classified by food access based on the United States (US) Department of Agriculture’s Food Access Research Atlas criteria: those in low-access areas were labeled AF-inside food desert (AFID) and those in high-access areas AF-outside food desert (AFOD). Zip codes defined exposure groups, and results like myocardial infarction, ischemic stroke, all-cause hospitalization, and mortality were extracted by using ICD-9/10 codes. Covariates included demographics, comorbidities, and medication use. Statistical analysis compared baseline characteristics with t-tests, Wilcoxon, or chi-square tests. Kaplan–Meier curves and log-rank tests assessed time-to-event differences. Cox proportional hazards and Fine-Gray competing risks models estimated adjusted hazard ratios (HR). Analyses were performed in R (v4.3.1) with significance set at P <0.05.
Out of 5947 AF patients in the REACHnet database, 1115 lived in AFID and 438 outside AFOD. 4394 were excluded due to geographical or heterogeneous zip codes. AFID patients were slightly younger (63 vs 65 years), more often female (39% vs 31%, P = 0.002), and predominantly Black (70% vs 20%, P < 0.001). AFOD patients were predominantly white (74% vs 27%, P < 0.001). AFID patients had a higher prevalence of hypertension, diabetes, congestive heart failure (CHF), coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), stroke history, smoking, alcohol use disorder, and higher prescription use.
Kaplan–Meier curves showed AFID patients had significantly worse results for composite events, hospitalization, and stroke (all P < 0.001). Five-year survival rates declined in AFID compared to AFOD, with composite outcomes (−69.8%), stroke (−15.5%), hospitalizations (−65.1%), and mortality (−7.1%, nonsignificant). AFID patients had a 42% higher risk (HR: 1.42, 95% confidence interval [CI]: 1.16 to 1.74, P < 0.001). Female sex, angiotensin-converting enzyme (ACE) inhibitor use, CAD, and anticoagulant use were significant predictors. Food desert residence was not significant after adjustment (sHR: 1.02, P = 0.83). Hypertension was protective (sHR: 0.61). Food desert residence was linked with over double stroke risk (sHR: 2.21, 95% CI: 1.12 to 4.36, P = 0.02). Age, CHF, hypertension, and MI were significant predictors. Food desert residence predicted fourfold higher mortality (sHR: 3.84, 95% CI: 1.39 to 10.61, P = 0.01). Additional predictors included anticoagulant use, diabetes, hypertension, and MI, while White race remained protective.
This study found that AF patients who reside in food deserts have a high risk of all-cause mortality, ischemic stroke, and composite outcomes. This is due to factors such as arterial stiffness, systemic inequities, high comorbidity burden, and malnutrition. Malnutrition can worsen AF prognosis by impairing immunity, decreasing cardiac muscle mass, and elevating the risk of complications and recurrence. This study highlights the important role of food access and social determinants of health in shaping AF outcomes.
References: Christianson E, Liu Y, Dahl A, et al. Impact of food desert residence on ischemic stroke and hospitalization risk in atrial fibrillation patients. JACC Adv. 2025;4(10, Part 2). doi:10.1016/j.jacadv.2025.102083
