Racial Differences in the Prevalence and Outcomes of Atrial Fibrillation in Patients Hospitalized With Heart Failure

Abstract

Previous research has shown that roughly 15% to 30% of those with heart failure (HF) develop atrial fibrillation (AF). Although studies have shown variations in the incidence of AF in patients with HF, there has been no evidence of mortality differences by race. The purpose of this study was to assess AF prevalence and inhospital mortality in patients with HF among different racial groups in the United States. Using the National Inpatient Sample registry, the largest publicly available all-payer inpatient care database representing >95% of the US inpatient population, we analyzed subjects hospitalized with a primary diagnosis of HF from 2001 to 2011 (n = 11,485,673) using the International Classification of Diseases, Ninth Edition (ICD 9) codes 428.0-0.1, 428.20-0.23, 428.30-0.33, 428.40-0.43, and 428.9; patients with AF were identified using the ICD 9 code 427.31. We assessed prevalence and mortality among racial groups. Using logistic regression, we examined odds of mortality adjusted for demographics and co-morbidity using Elixhauser co-morbidity index. We also examined utilization of procedures by race. Of the 11,485,673 patients hospitalized with HF in our study, 3,939,129 (34%) had AF. Patients with HF and AF had greater inhospital mortality compared with those without AF (4.6% vs 3.3% respectively, p <0.0001). Additionally, black, Hispanic, Asian, and white patients with HF and AF had a 24%, 17%, 13%, and 6% higher mortality, respectively, than if they did not have AF. Among patients with HF and AF, minority racial groups had underutilization of catheter ablation and cardioversion compared with white patients. In conclusion, minority patients with HF and AF had a disproportionately higher risk of inpatient death compared with white patients with HF. We also found a significant underutilization of cardioversion and catheter ablation in minority racial groups compared with white patients.

Ethnicity and anticoagulation management of hospitalized patients with atrial fibrillation in northwest China

“…From this perspective, the real status of anticoagulation is rather discouraging. Previously, we found a similar phenomenon11 in which a cardioversion and catheter ablation were significantly underutilized in minority ethnic groups.…”

“…In addition, among patients with HF and AF, minority racial groups were shown to underutilize treatment and have disproportionately higher risks of inpatient death11. In regards to treatment strategies, studies have shown that ethnicity may affect anticoagulation81012 and cardiac ablation13 in patients with AF.…”

Ethnic differences in atrial fibrillation in patients with heart failure from Asia-Pacific

“…In the National Inpatient Sample registry, an inverse correlation of AF with diabetes in Asian patients with HF was seen; among whom those with AF had less diabetes compared with those without (41% vs 52%, p<0.001) 7. In the GWTG-HF Registry, patients with HF and diabetes had a lower prevalence of chronic or recurrent AF than those without diabetes (32% vs 38%, p<0.001), although patients from this registry were predominantly white (69% vs 2% Asian) and separate analyses between different ethnicities were not performed 20.…”

“…Additionally, Bathia et al had previously described a higher proportion of whites in patients with HF and AF when compared with blacks, Asians and Hispanics, but had the lowest rate of diabetes, hypertension, cardiomyopathy, hyperthyroidism and second lowest rate of obesity, all of which are well-recognised risk factors of AF 7. Findings from our study are in agreement, suggesting that the higher prevalence of AF among white patients may be due to an inherent ethnicity-specific characteristic.…”

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

“…1,2 Beyond traditional risk factors, there is growing evidence of ethnic influences on the prevalence of AF in the context of HF. [3][4][5][6][7] A large US registry reported a higher prevalence of AF among white HF patients compared with blacks, Hispanics, and Asians 3 ; while a prospective Asia Pacific study showed a distinctly lower prevalence of AF among Singaporean-Asian compared with New Zealand European HF patients. 5 The ethnic differences in AF prevalence in HF, while striking, remain poorly understood.…”