Atrial fibrillation affects almost 60 million adults worldwide. Atrial fibrillation is associated with a high risk of cardiovascular morbidity and death as well as with social, psychological and economic burdens on patients and their families. Social determinants -such as race and ethnicity, financial resources, social support, access to health care, rurality and residential environment, local language proficiency and health literacy -have prominent roles in the evaluation, treatment and management of atrial fibrillation. Addressing the social determinants of health provides a crucial opportunity to reduce the substantial clinical and non-clinical complications associated with atrial fibrillation. In this Review, we summarize the contributions of social determinants to the patient experience and outcomes associated with this common condition. We emphasize the relevance of social determinants and their important intersection with atrial fibrillation treatment and outcomes. In closing, we identify gaps in the literature and propose future directions for the investigation of social determinants and atrial fibrillation.Atrial fibrillation (AF) is the most commonly encountered cardiac rhythm disorder, affecting nearly 60 million adults worldwide in 2019 and contributing to substantial social and medical burdens 1,2 . AF is associated with myriad cardiovascular and non-cardiovascular outcomes, including well-recognized outcomes such as heart failure, myocardial infarction, ischaemic stroke and death, as well as frailty, cognitive decline and high health-care utilization 3 . Social determinants of health contribute to the recognition, evaluation, treatment and outcomes of diverse disease states but have had limited examination in AF. Given their

ED patients with LEP experienced both increased rates of diagnostic testing and of hospital admission. Research is needed to examine why these differences occurred and if they represent inefficiencies in care.

Key Points Question How has telehealth use during the COVID-19 pandemic varied across pediatric subspecialties, and was telehealth associated with changes in no-show rates and access disparities? Findings This cohort study of 8 large pediatric medical groups in California found high variability in telehealth use across subspecialties but no association between telehealth volume and clinic no-show rates. Although overall visits remained stable from the prepandemic to pandemic periods, English-speaking patients and patients of ethnicities other than Hispanic were more likely to be seen via telehealth. Meaning Documenting variation in telehealth adoption can inform telehealth policy, including the appropriateness of telehealth for different patient needs and areas where additional tools are needed to promote use.