Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control

Gomez, Sofia; Fazal, Muhammad; Nunes, Julio C.; Shah, Shayena; Perino, Alexander C; Narayan, Sanjiv M.; Tamirisa, Kamala P.; Han, Janet K.; Rodríguez, Fátima; Baykaner, Tina

doi:10.1007/s10840-022-01383-x

Cited by 10 publications

(7 citation statements)

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“…Specifically, persons identifying with an ethnoracial minority group may have more challenging access to health care, worse clinical outcomes, and higher dissatisfaction with care compared to White persons [1][2][3][4][5]. There are differences by ethnoracial group in the prevalence of the three most common indications for which anticoagulants are prescribed, stroke prevention in atrial fibrillation (AF), treatment of venous thromboembolism (VTE), and valvular heart disease [6][7][8][9][10][11][12][13][14][15][16][17]. Specifically, VTE is most prevalent in Black patients compared to White and Asian patients, whereas AF is most prevalent in White patients compared to Black, Asian, and Hispanic patients [9,10,15].…”

Section: Introductionmentioning

confidence: 99%

Differences in quality of anticoagulation care delivery according to ethnoracial group in the United States: A scoping review

Vazquez,

Yates,

Beavers

et al. 2024

J Thromb Thrombolysis

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Anticoagulation therapy is standard for conditions like atrial fibrillation, venous thromboembolism, and valvular heart disease, yet it is unclear if there are ethnoracial disparities in its quality and delivery in the United States. For this scoping review, electronic databases were searched for publications between January 1, 2011 – March 30, 2022. Eligible studies included all study designs, any setting within the United States, patients prescribed anticoagulation for any indication, outcomes reported for ≥ 2 distinct ethnoracial groups. The following four research questions were explored: Do ethnoracial differences exist in 1) access to guideline-based anticoagulation therapy, 2) quality of anticoagulation therapy management, 3) clinical outcomes related to anticoagulation care, 4) humanistic/educational outcomes related to anticoagulation therapy. A total of 5374 studies were screened, 570 studies received full-text review, and 96 studies were analyzed. The largest mapped focus was patients’ access to guideline-based anticoagulation therapy (88/96 articles, 91.7%). Seventy-eight articles made statistical outcomes comparisons among ethnoracial groups. Across all four research questions, 79 articles demonstrated favorable outcomes for White patients compared to non-White patients, 38 articles showed no difference between White and non-White groups, and 8 favored non-White groups (the total exceeds the 78 articles with statistical outcomes as many articles reported multiple outcomes). Disparities disadvantaging non-White patients were most pronounced in access to guideline-based anticoagulation therapy (43/66 articles analyzed) and quality of anticoagulation management (19/21 articles analyzed). Although treatment guidelines do not differentiate anticoagulant therapy by ethnoracial group, this scoping review found consistently favorable outcomes for White patients over non-White patients in the domains of access to anticoagulation therapy for guideline-based indications and quality of anticoagulation therapy management. No differences among groups were noted in clinical outcomes, and very few studies assessed humanistic or educational outcomes. Graphical Abstract Scoping Review: Differences in quality of United States anticoagulation care delivery by ethnoracial group. AF = atrial fibrillation; AMS = anticoagulation management service; DOACs = direct oral anticoagulants; INR = international normalized ratio; PSM = patient self-management; PST = patient self-testing

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Section: Introductionmentioning

confidence: 99%

Differences in quality of anticoagulation care delivery according to ethnoracial group in the United States: A scoping review

Vazquez,

Yates,

Beavers

et al. 2024

J Thromb Thrombolysis

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“…5 Its incidence is higher in men than in women. 6,7 Hypertension, another important public health problem, affects approximately 20-50% of the adult population worldwide, and its prevalence is increasing. 8 AF is associated with hypertension, and patients with hypertension have a 1.7-fold higher risk of developing AF than normotensive patients.…”

Section: Introductionmentioning

confidence: 99%

“…In the Chinese adult population, the prevalence of AF has increased from 0.40% to 0.45% between 2012 and 2017 to approximately 1.6% from 2020 to 2021, 3,4 leading to a significant economic burden 5 . Its incidence is higher in men than in women 6,7 . Hypertension, another important public health problem, affects approximately 20–50% of the adult population worldwide, and its prevalence is increasing 8 .…”

Section: Introductionmentioning

confidence: 99%

Downregulation of fibromodulin attenuates inflammatory signaling and atrial fibrosis in spontaneously hypertensive rats with atrial fibrillation via inhibiting TLR4/NLRP3 signaling pathway

Liang,

Zhou,

Wang

et al. 2023

Immunity Inflam & Disease

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BackgroundMyocardial fibrosis is an important factor in the induction and maintenance of atrial fibrillation (AF). Fibromodulin (FMOD) promotes fibrotic gene expression. However, its specific role in spontaneously hypertensive rats (SHR)‐AF remains unclear.MethodsWe analyzed FMOD mRNA and protein expression in rat atrial tissues using RT‐qPCR, Western blot analysis, and immunohistochemistry. Histopathological examination of atrial tissues was performed using hematoxylin and eosin (H&E), Masson's trichrome, and Picrosirius red staining. The levels of inflammatory and fibrosis‐related proteins were measured using Western blot analysis.ResultsFMOD relative mRNA and protein expression levels were notably upregulated in atrial tissues of both AF groups (normal‐AF and SHR‐AF groups) than that in atrial tissues of the no‐AF group (normal and SHR group). This effect was particularly pronounced in the SHR‐AF group. Pathological changes revealed that the extracellular matrix, collagen, collagen fibers, and left atrial diameter were notably increased in the atrial tissues from the SHR‐AF group compared to those in the atrial tissues from the SHR group, whereas the left ventricular fractional shortening and left ventricular ejection fraction were notably lower. Expression of TLR4, MyD88, NLRP3, TGF‐β1, collagen I, and collagen II mRNA were clearly higher in atrial tissues from the SHR‐AF group than in those from the SHR group. Protein levels of TLR4, MyD88, NLRP3, Cleavage‐Caspase‐1, Cleavage‐IL‐1β, TGF‐β1, p‐Smad2, collagen I, and collagen II were clearly higher in atrial tissues from the SHR‐AF group than in those from the SHR group. FMOD knockdown inhibited atrial fibrosis, collagen accumulation, and the TLR4/MyD88/NLRP3 signaling pathway.ConclusionDownregulation of FMOD attenuated inflammatory signaling and atrial fibrosis in SHR‐AF by inhibiting the TLR4/NLRP3 signaling pathway. Therefore, FMOD may be a promising therapeutic target in AF.

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“…20 Despite the clear utility of stroke rehabilitation, our understanding of the extent of disparities in rehabilitation care across specific sociodemographic characteristics (e.g., by age, sex, race, ethnicity, rurality, socioeconomic status [SES]) is limited. While several reviews have been conducted on disparities in acute stroke management and stroke prevention, [21][22][23][24][25][26] to our knowledge, none exists for disparities in stroke rehabilitation. Filling this gap is particularly important given that the incidence of stroke and outcomes following stroke disproportionally affect certain demographic and socioeconomic groups identified as disparity populations.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Access to, Use of, and Quality of Rehabilitation Care Following Stroke: A Scoping Review

Freburger,

Mormer,

Ressel

et al. 2023

Preprint

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Despite the clear utility of stroke rehabilitation, our understanding of the extent of disparities in rehabilitation care across specific sociodemographic characteristics (e.g., by age, sex, race, ethnicity, rurality, socioeconomic status) is limited. In this review, we aimed to synthesize the current evidence on disparities in referral to, use of, and quality of rehabilitation following stroke; identify research gaps in our understanding of disparities in rehabilitation care; and make recommendations for future research to advance the field in identifying, understanding the causes of, and minimizing disparities. We searched three electronic databases from 1997 to 2023 for cohort, case-control, cross-sectional, observational, and mixed-method studies that examined disparities in rehabilitation care following stroke. From 7,853 records screened, we identified 49 studies that met our inclusion criteria. Findings from the studies we reviewed varied, with the most consistent findings indicating that individuals with lower socioeconomic status and those living in rural areas (vs urban) are less likely to receive rehabilitation care following stroke. Findings on racial, ethnic, and sex disparities varied with some consistent findings among specific subgroups (e.g., studies examining care in the outpatient setting) and when examining results from analyses that controlled for functional status and other measures of “need” for therapy. Several gaps in our understanding of disparities in rehabilitation care following stroke were identified. Recommendations for future work were also provided.

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Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control

Cited by 10 publications

References 100 publications

Differences in quality of anticoagulation care delivery according to ethnoracial group in the United States: A scoping review

Differences in quality of anticoagulation care delivery according to ethnoracial group in the United States: A scoping review

Downregulation of fibromodulin attenuates inflammatory signaling and atrial fibrosis in spontaneously hypertensive rats with atrial fibrillation via inhibiting TLR4/NLRP3 signaling pathway

Disparities in Access to, Use of, and Quality of Rehabilitation Care Following Stroke: A Scoping Review

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