Racial/ethnic differences in atrial fibrillation symptoms, treatment patterns, and outcomes: Insights from Outcomes Registry for Better Informed Treatment for Atrial Fibrillation Registry

• Published in: The American heart journal Vol. 174; pp. 29 - 36
• Main Authors: Golwala, Harsh, MD, Jackson, Larry R., MD, Simon, DaJuanicia N., MS, Piccini, Jonathan P., MD, MHS, Gersh, Bernard, MB, ChB, DPhil, Go, Alan S., MD, Hylek, Elaine M., MD, MPH, Kowey, Peter R., MD, FAHA, Mahaffey, Kenneth W., MD, Thomas, Laine, PhD, Fonarow, Gregg C., MD, Peterson, Eric D., MD, MPH, Thomas, Kevin L., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2016; Elsevier Limited
• Subjects: Aged; Anticoagulants; Anticoagulants - therapeutic use; Atrial Fibrillation - complications; Atrial Fibrillation - ethnology; Atrial Fibrillation - therapy; Cardiac arrhythmia; Cardiac Resynchronization Therapy - methods; Cardiovascular; Continental Population Groups; Demographics; Disease Management; Embolism - ethnology; Embolism - etiology; Embolisms; Ethnic Groups; Ethnicity; Family medical history; Female; Follow-Up Studies; Hispanic people; Hospitalization; Humans; Incidence; Male; Mortality; Prognosis; Quality of Life; Race; Registries; Review boards; Stroke; Stroke - ethnology; Stroke - etiology; Studies; Survival Rate - trends; Time Factors; United States - epidemiology; United States; United States > US
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2015.10.028

Background Significant racial/ethnic differences exist in the incidence of atrial fibrillation (AF). However, less is known about racial/ethnic differences in quality of life (QoL), treatment, and outcomes associated with AF. Methods Using data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we compared clinical characteristics, QoL, management strategies, and long-term outcomes associated with AF among various racial/ethnic groups. Results We analyzed 9,542 participants with AF (mean age 74 ± 11 years, 43% women, 91% white, 5% black, 4% Hispanic) from 174 centers. Compared with AF patients identified as white race, patients identified as Hispanic ethnicity and those identified as black race were younger, were more often women, and had more cardiac and noncardiac comorbidities. Black patients were more symptomatic with worse QoL and were less likely to be treated with a rhythm control strategy than other racial/ethnic groups. There were no significant racial/ethnic differences in CHA2 DS2 -VASc stroke or ATRIA bleeding risk scores and rates of oral anticoagulation use were similar. However, racial and ethnic minority populations treated with warfarin spent a lower median time in therapeutic range of international normalized ratio (59% blacks vs 68% whites vs 62% Hispanics, P < .0001). There was no difference in long-term outcomes associated with AF between the 3 groups at a median follow-up of 2.1 years. Conclusion Relative to white and Hispanic patients, black patients with AF had more symptoms, were less likely to receive rhythm control interventions, and had lower quality of warfarin management. Despite these differences, clinical events at 2 years were similar by race and ethnicity.