Prevalence of Diagnosed Atrial Fibrillation in Adults

Go, Alan S.; Hylek, Elaine M.; Phillips, Kathleen A.; Chang, Yuchiao; Henault, Lori; Selby, Joe V.; Singer, Daniel E.

doi:10.1001/jama.285.18.2370

Cited by 5,495 publications

(1,462 citation statements)

References 15 publications

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“…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%

“…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. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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Rates of Atrial Fibrillation in Black Versus White Patients With Pacemakers

Kamel

Kleindorfer

Bhave

et al. 2016

JAHA

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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.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rates of Atrial Fibrillation in Black Versus White Patients With Pacemakers

Kamel

Kleindorfer

Bhave

et al. 2016

JAHA

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“…Atrial fibrillation affects 3-5% in patients older than 65 years and is responsible for 15-20% of strokes [15]. Due to the risk of thromboembolism many patients with atrial fibrillation are treated with anticoagulants.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced CMR in patients after percutaneous closure of the left atrial appendage: A pilot study

Mohrs

Wunderlich

Petersen

et al. 2011

Journal of Cardiovascular Magnetic Resonance

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BackgroundTo evaluate the feasibility and value of first-pass contrast-enhanced dynamic and post-contrast 3D CMR in patients after transcatheter occlusion of left atrial appendage (LAA) to identify incorrect placement and persistent leaks.Methods7 patients with different occluder systems (n = 4 PLAATO; n = 2 Watchman; n = 1 ACP) underwent 2 contrast-enhanced (Gd-DOTA) CMR sequences (2D TrueFISP first-pass perfusion and 3D-TurboFLASH) to assess localization, artifact size and potential leaks of the devices. Perfusion CMR was analyzed visually and semi-quantitatively to identify potential leaks.ResultsAll occluders were positioned within the LAA. The ACP occluder presented the most extensive artifact size. Visual assessment revealed a residual perfusion of the LAA apex in 4 cases using first-pass perfusion and 3D-TurboFLASH indicating a suboptimal LAA occlusion.By assessing signal-to-time-curves the cases with a visually detected leak showed a 9-fold higher signal-peak in the LAA apex (567 ± 120% increase from baseline signal) than those without a leak (61 ± 22%; p < 0.03). In contrast, the signal increase in LAA proximal to the occluder showed no difference (leak 481 ± 201% vs. no leak 478 ± 125%; p = 0.48).ConclusionThis CMR pilot study provides valuable non-invasive information in patients after transcatheter occlusion of the LAA to identify correct placement and potential leaks. We recommend incorporating CMR in future clinical studies to evaluate new device types.

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“…Atrial fibrillation (AF) is a common but important type of arrhythmia because of the high risk of cerebral thromboembolism, which can be fatal 1, 2. A close relationship between AF and chronic renal dysfunction has been demonstrated in the several clinical trials 3, 4, 5, 6, 7.…”

mentioning

confidence: 99%

Role of Indoxyl Sulfate as a Predisposing Factor for Atrial Fibrillation in Renal Dysfunction

Aoki

Teshima

Kondo

et al. 2015

JAHA

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BackgroundRenal dysfunction is a major risk factor for atrial fibrillation (AF). The uremic toxin indoxyl sulfate may contribute to the progression of cardiac fibrosis and AF substrate in renal dysfunction.Methods and ResultsMale Sprague–Dawley rats were assigned randomly to the following groups: 5/6 nephrectomy (5/6Nx) with vehicle, 5/6Nx with AST‐120, sham procedure with vehicle, and sham procedure with AST‐120. Vehicle and AST‐120 were administered for 4 weeks. Serum levels of IS were significantly increased in 5/6Nx groups. Expression of malondialdehyde, an indicator of oxidative stress, was upregulated in the left atrium of 5/6Nx groups and was accompanied by an increase in expression of NADPH oxidase 2 and 4. Monocyte‐mediated inflammatory signals such as CD68, monocyte chemoattractant protein 1, and vascular cell adhesion molecule 1 were also upregulated in 5/6Nx groups. Interstitial fibrosis was promoted heterogeneously, and expression of profibrotic indicators such as transforming growth factor β1, α‐smooth muscle actin, and collagen type 1 was upregulated in left atrium tissue of 5/6Nx groups. In cultured atrial fibroblasts, incubation with IS upregulated expression of the markers of oxidative stress, inflammation, and profibrotic factors. These results suggest the direct effects of IS on the progression of AF substrate. AF was consistently and invariably induced by atrial extrastimuli in 5/6Nx groups in electrophysiological experiments. AST‐120 treatment significantly alleviated renal dysfunction–induced oxidative stress, inflammation, and atrial fibrosis and, consequently, attenuated AF inducibility.ConclusionsIndoxyl sulfate facilitates atrial fibrosis and AF and thus is a novel therapeutic target for prevention of renal dysfunction–induced AF.

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Prevalence of Diagnosed Atrial Fibrillation in Adults

Cited by 5,495 publications

References 15 publications

Rates of Atrial Fibrillation in Black Versus White Patients With Pacemakers

Rates of Atrial Fibrillation in Black Versus White Patients With Pacemakers

Contrast-enhanced CMR in patients after percutaneous closure of the left atrial appendage: A pilot study

Role of Indoxyl Sulfate as a Predisposing Factor for Atrial Fibrillation in Renal Dysfunction

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