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Background Low socioeconomic status is associated with cardiovascular diseases, and an association with atrial fibrillation (AF) could guide screening. Aim To investigate if indices of advantage/disadvantage (IAD), index of education/occupation (IEO) and index of economic resources were associated with incident AF, independent of risk factors and cardiac function. Methods We studied community‐based participants aged ≥65 years with AF risk factors (n = 379, age 70 ± 4 years, 45% men). The CHARGE‐AF score (a well validated AF risk score) was used to assess 5‐year risk of developing AF. Participants also had baseline echocardiograms. IAD, IEO and index of economic resources were obtained from the 2011 Socio‐Economic Indexes for Areas score, in which higher decile ranks indicate more advantaged areas. Patients were followed up for incident AF (median 21 (range 5–31) months), with AF diagnosed by clinical review, including 12‐lead electrocardiogram (ECG), as well as single‐lead portable ECG monitoring used to record 60 s ECG tracings five times/day for 1 week. Cox proportional hazards models were used to assess the association between socioeconomic status and incident AF. Results Subjects with AF (n = 50, 13%) were more likely to be male (64 vs 42%, P = 0.003) and had higher CHARGE‐AF score (median 7.1% (5.2–12.8%) vs 5.3% (3.3–8.6%), P < 0.001). Areas with lower socioeconomic status (IAD and IEO) had a higher risk of incident AF independent of LV function and CHARGE‐AF score (hazard ratio for IAD 1.16, 95% confidence interval 1.05–1.29, P = 0.005 and hazard ratio for IEO 1.18, 95% confidence interval 1.07–1.30, P = 0.001). Conclusion Regional socioeconomic status is associated with risk of incident AF, independent of LV function and clinical risk. This association might permit better regional targeting of prevention.

Penetrating trauma to the heart has a high associated mortality due to significant hemorrhage, coronary artery injury, and cardiac tamponade. Such sequelae progress rapidly, often leading to death before reaching hospital. We report a case of delayed presentation following a stab injury to the right ventricle. This case highlights the mechanisms that may facilitate a delayed presentation and the importance of appropriate investigation when suspicion of cardiac injury is high.

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