Ethnic differences in atrial fibrillation among patients with heart failure in Asia

Abstract

Aims We aimed to characterize ethnic differences in prevalence, clinical correlates, and outcomes of atrial fibrillation (AF) in heart failure (HF) with preserved and reduced ejection fraction (HFpEF and HFrEF) across Asia. Methods and results Among 5504 patients with HF prospectively recruited across 11 Asian regions using identical protocols in the Asian Sudden Cardiac Death in Heart Failure study (mean age 61 ± 13 years, 27% women, 83% HFrEF), 1383 (25%) had AF defined as a history of AF and/or AF/flutter on baseline electrocardiogram. Clinical correlates of AF were similar across ethnicities and included older age, prior stroke, higher NT-proBNP, and larger left atria. Diabetes was associated with lower odds of AF in HFrEF [adjusted odds ratio (AOR) 0.79, 95% CI 0.66-0.95] and HFpEF (AOR 0.58, 95% CI 0.39-0.84) regardless of ethnicity. Compared with Chinese ethnicity, Japanese/Koreans had higher odds of AF in HFrEF (AOR 1.76, 95% CI 1.40-2.21), while Indians had lower odds in HFrEF (AOR 0.18, 95% CI 0.13-0.24) and HFpEF (AOR 0.28, 95% CI 0.16-0.49) even after adjusting for clinical covariates. Interaction between ethnicity and region was observed among Indians, with Southeast Asian Indians having higher odds of AF (AOR 3.01, 95% CI 1.60-5.67) compared with South Asian Indians. AF was associated with poorer quality of life and increased risk of 1 year all-cause mortality or HF hospitalisation (adjusted hazard ratio 1.39, 95% CI 1.18-1.63) regardless of ethnicity. Conclusions Among patients with HF across Asia, clinical correlates and adverse outcomes associated with AF are similar across ethnicities; however, there are striking ethnic variations in the prevalence of AF that are not accounted for by known risk factors.

Sex and ethnicity modified high 1-year mortality in patients in Singapore with newly diagnosed atrial fibrillation

“…26,27 The effects of sex and ethnicity on mortality from AF were, however, more variable, with sex differences not observed 10-13 but ethnic differences among Asians with HF reported. 24 Despite the high prevalence of hypertension, diabetes and HF in Southeast Asia, 28 there is a paucity of data on AF characteristics and mortality in this region. [29][30][31] Therefore, we investigated sex and ethnic differences in the incidence, clinical characteristics and 1-year mortality of patients with newly diagnosed AF in a nationwide, multiethnic population in Singapore.…”

“…These variations might lead to atrial structural and electrophysiological properties that result in Indians being less susceptible to AF. [24][25][26] Differences in AF rates between Malays and Chinese are likely a reflection of the higher cardiovascular risk profile among Malays, while differences in local dietary habits and activity levels may also contribute, with the effects of lifestyle modifications on maintenance of sinus rhythm being highlighted previously in a study. 35 The higher prevalence of inpatient diagnoses of AF among Malays may also suggest a worse comorbid status.…”

“…[10][11][12][13][14][15][16][17][18][19][20][21][22] Significant heterogeneities in AF prevalence were observed within Asian populations. [23][24][25] While not fully understood, these differences may be contributed by the…”

Different strokes for different folks

“…Regionally, there are interesting differences observed in the prevalence, clinical correlates and outcomes of AF in heart failure patients across Asia. 4 A previous community-based study in Singapore showed a relatively low AF prevalence rate in the Chinese community over the age of 55 years old. 5 In this issue of the Annals, Tan et al had taken further steps to illustrate the interesting differences in the mortality and incidences in multiethnic Singapore.…”