Ethnic Differences in Atrial Fibrillation Identified Using Implanted Cardiac Devices

Lau, Chu‐Pak; Gbadebo, T. David; Connolly, Stuart J.; Gelder, Isabelle C. Van; Capucci, Alessandro; Gold, Michael R.; Israel, Carsten W.; Morillo, Carlos A.; Siu, Chung‐Wah; Abe, Haruhiko; Carlson, Mark D.; Tse, Hung‐Fat; Hohnloser, Stefan H.; Healey, Jeff S.; Investigators, Assert

doi:10.1111/jce.12066

Cited by 57 publications

(49 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These findings are consistent with the results of several prior studies that found lower rates of AF in black compared with white patients 3, 4, 5, 6, 7, 8, 9, 10, 11. These studies involved analysis of administrative claims data in all patients presenting for acute care,3 prospective ascertainment of AF based on periodic ECG screening and hospitalization records,4, 5, 6, 7, 8 or examination of electronic medical records to identify clinical diagnoses of AF or ECGs showing AF 9, 10.…”

Section: Discussionsupporting

confidence: 93%

“…Because none of these approaches involved long‐term continuous heart‐rhythm monitoring, their results may have reflected differences in AF symptomatology or patterns of care between white and black patients that resulted in differential ascertainment of AF12, 13 rather than true differences in the burden of AF. A prospective study assessed racial differences in AF detection using pacemakers or implanted defibrillators, but this study included a small number of black patients and was able to adjust for a limited number of potentially confounding factors 11. Our results build on these prior studies by focusing on a large population with indwelling pacemakers who thus underwent frequent interrogation of their heart rhythms.…”

Section: Discussionmentioning

confidence: 98%

“…Conversely, studies consistently report that black patients have lower rates of atrial fibrillation (AF)—one of the strongest risk factors for stroke2—than white patients 3, 4, 5, 6, 7, 8, 9, 10, 11. It is unclear whether the lower reported rate of AF in black persons represents a truly lower burden of AF or more frequent underdiagnosis of this often paroxysmal dysrhythmia in black persons 12, 13.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Rates of Atrial Fibrillation in Black Versus White Patients With Pacemakers

Kamel

Kleindorfer

Bhave

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundBlack US residents experience higher rates of ischemic stroke than white residents but have lower rates of clinically apparent atrial fibrillation (AF), a strong risk factor for stroke. It is unclear whether black persons truly have less AF or simply more undiagnosed AF.Methods and ResultsWe obtained administrative claims data from state health agencies regarding all emergency department visits and hospitalizations in California, Florida, and New York. We identified a cohort of patients with pacemakers, the regular interrogation of which reduces the likelihood of undiagnosed AF. We compared rates of documented AF or atrial flutter at follow‐up visits using Kaplan–Meier survival statistics and Cox proportional hazards models adjusted for demographic characteristics and vascular risk factors. We identified 10 393 black and 91 380 white patients without documented AF or atrial flutter before or at the index visit for pacemaker implantation. During 3.7 (±1.8) years of follow‐up, black patients had a significantly lower rate of AF (21.4%; 95% CI 19.8–23.2) than white patients (25.5%; 95% CI 24.9–26.0). After adjustment for demographic characteristics and comorbidities, black patients had a lower hazard of AF (hazard ratio 0.91; 95% CI 0.86–0.96), a higher hazard of atrial flutter (hazard ratio 1.29; 95% CI 1.11–1.49), and a lower hazard of the composite of AF or atrial flutter (hazard ratio 0.94; 95% CI 0.88–99).ConclusionsIn a population‐based sample of patients with pacemakers, black patients had a lower rate of AF compared with white patients. These findings indicate that the persistent racial disparities in rates of ischemic stroke are likely to be related to factors other than undiagnosed AF.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Rates of Atrial Fibrillation in Black Versus White Patients With Pacemakers

Kamel

Kleindorfer

Bhave

et al. 2016

JAHA

View full text Add to dashboard Cite

show abstract

“…40 Studies comparing AF prevalence across different racial groups have shown heterogeneity with a higher prevalence in whites compared with blacks, Hispanics, and Asians. 32,49,53,54 This difference remains even if AF prevalence is studied in pacemaker studies, in which differences in healthcare consumption patterns are of no importance. 54 Even though AF was less common in blacks compared with whites in a study of an American biracial population, stroke remained a vast problem, with higher incidence rates than in the white population, 55 raising the possibility that the importance of AF as a risk factor for stroke might vary between ethnic groups.…”

Section: Limitationsmentioning

confidence: 98%

Mass Screening for Untreated Atrial Fibrillation

et al. 2015

View full text Add to dashboard Cite

Background-The aims of the present study were to define the prevalence of untreated atrial fibrillation (AF) in a systematic screening program using intermittent ECG recordings among 75-to 76-year-old individuals and to study the feasibility of initiating protective oral anticoagulant (OAC) treatment. Methods and Results-Half of the 75-to 76-year-old population in 2 Swedish regions were invited to a screening program for AF. Participants without a previous diagnosis of AF underwent intermittent ECG recordings over 2 weeks. If AF was detected, participants were offered OAC. During the 28-month inclusion period, 13 331 inhabitants were invited. Of these, 7173 (53.8%) participated. Of the participants, 218 (3.0%; 95% confidence interval [CI], 2.7-3.5) were found to have previously unknown AF, and of these, AF was found in 37 (0.5% of the screened population) on their first ECG. The use of intermittent ECGs increased new AF detection 4-fold. A previous diagnosis of AF was known in 9.3% (n=666; 95% CI, 8.6-10.0). Total AF prevalence in the screened population was 12.3%. Of participants with known AF, 149 (2.1%; 95% CI, 1.8-2.4) had no OAC treatment. In total, 5.1% (95% CI, 4.6-5.7) of the screened population had untreated AF; screening resulted in initiation of OAC treatment in 3.7% (95% CI, 3.3-4.2) of the screened population. More than 90% of the participants with previously undiagnosed AF accepted initiation of OAC treatment. Conclusions-Mass

show abstract

“…11 Continuous monitoring with implantable devices, however, does not support this phenomenon and instead corroborates the presently observed higher incidence of AF among whites. 12 To further evaluate for this proposed ascertainment bias, we used discharge coding patterns to classify AF as intermittent or continuous and stratified our analysis by AF type. Because the association between race and AF was consistent in these analyses, our results do not support the hypothesis that reduced AF ascertainment in blacks entirely accounts for the observed association between race and AF.…”

Section: Discussionmentioning

confidence: 99%