Regional and Socioeconomic Disparities in the Diagnosis of Primary Electrical Diseases in a Universal Healthcare System: A Nationwide Danish Study

Priya Bhardwaj; Bo Gregers Winkel; Rasmus Bork Dinesen; Christian Torp-Pedersen; Stine Bøttcher Jacobsen; Arthur A M Wilde; Carl Johann Hansen; Jacob Tfelt-Hansen

doi:10.1093/ehjqcco/qcag069

Regional and Socioeconomic Disparities in the Diagnosis of Primary Electrical Diseases in a Universal Healthcare System: A Nationwide Danish Study

Eur Heart J Qual Care Clin Outcomes. 2026 Apr 18:qcag069. doi: 10.1093/ehjqcco/qcag069. Online ahead of print.

Authors

Priya Bhardwaj^{1

2}, Bo Gregers Winkel^{1

3

4}, Rasmus Bork Dinesen¹, Christian Torp-Pedersen^{5

3}, Stine Bøttcher Jacobsen^{1

2}, Arthur A M Wilde^{6

4}, Carl Johann Hansen¹, Jacob Tfelt-Hansen^{1

2

4}

Affiliations

¹ Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
² Section of Forensic Genetics, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark.
³ Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
⁴ Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu).
⁵ Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark.
⁶ Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam UMC, Amsterdam, The Netherlands.

PMID: 41999290
DOI: 10.1093/ehjqcco/qcag069

Abstract

Background: Primary electrical diseases (PED) carry a significant risk of sudden cardiac death (SCD). Diagnosis, management, and access to care vary across regions even within universal healthcare systems. We examined nationwide geographic, socioeconomic, and treatment disparities in Denmark.

Methods: We conducted a nationwide registry-based study of individuals diagnosed with PED (long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia) between 2007 and 2024 in Denmark. Cases were compared to sex- and age matched individuals in the background population. Outcomes included disease prevalence, proximity to specialized clinics, treatment patterns, comorbidities, and socioeconomic status.

Results: We identified 1,132 individuals with PED. Overall prevalence was 19.0 per 100,000, with regional variation highest in North Denmark (26.8) and lowest in Central Denmark (12.9). Prevalence was higher in capital municipalities than in other municipality types. Cases lived closer to specialized inherited cardiac clinics than matched controls (50% shorter distance in the Capital Region; 18.9% shorter in Southern Denmark). Psychiatric comorbidities, notably anxiety and affective disorders, were more frequent in cases than controls (15% vs 11%). Beta-blocker use and ICD implantation were markedly higher in cases with regional variation. Socioeconomic differences were modest, with immigrants underrepresented among diagnosed cases.

Conclusion: Even within a universal healthcare system, geographic and systemic factors contribute to disparities in the diagnosis and management of PED. Differences in proximity to specialized clinics, regional referral practices, and treatment patterns may influence detection and care. Targeted strategies to improve awareness, referral pathways, and equitable access are needed to optimize diagnosis, management, and SCD prevention.

Keywords: Healthcare disparities; Primary electrical diseases; Quality of care; SCD.

© The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.