KEY TAKEAWAYS

• About 1 million Canadians and 5.2 million Americans have AF. In the United States, individuals with AF are expected to reach 12.1 million by 2030.
• AF prevalence is about 1% in Asia and 0.7% to 5.5% in Africa. Given the population growth in Africa and Asia by 2050, 60 to 70 million Asians will have AF by 2050 whereas Africa will have the highest AF population.
• Blacks have a lower incidence and prevalence of AF than whites despite higher exposure to traditional AF risk factors than whites.

INTRODUCTION

ATRIAL FIBRILLATION-RELATED MORTALITY

Blacks Have Higher rates of Atrial Fibrillation-related mortality.

• Compared to white patients with AF, black patients are more prone to suffer from complications such as stroke, heart failure, and death. According to one study that used rate differences to determine the connection of these effects with race, white people with AF had a rate difference of 55.9 for mortality compared to their black counterparts, who had a rate difference of 106.0.
• When compared to white patients with heart failure and AF, minorities have a greater in-hospital mortality rate. According to a study examining racial differences in mortality rates in patients with both heart failure and AF and those without AF, black, Hispanic, Asian, and white patients with HF and AF had a 24%, 17%, 13%, and 6% greater mortality, respectively, than those without AF.
• Blacks have a higher mortality rate than whites in patients with AF alone. A study found that stroke, heart failure, coronary artery disease, and death were 1.5 to 2 times more likely in Black patients with AF than white individuals.
• Another study reported that being black was an independent predictor of in-hospital fatality.

 

Source

Management-Related Mortality

Rate or Rhythm Control Strategy

• One of the methods of managing AF is the prevention of circulatory instability, achieved through rate or rhythm control. One study indicated that blacks who underwent rhythm control for atrial fibrillation (AF) had a greater adjusted risk of death compared to whites.
• A study evaluating inpatient, outpatient, and pharmacy claims data from the Optum Clinformatics Data Mart between October 1, 2015, and June 30, 2019, found that blacks were associated with reduced utilization of rhythm control strategies, including use of AADS and catheter ablations. The use of antiarrhythmic medications (AADs) or catheter ablation to manage paroxysmal atrial fibrillation (AF) has been linked to a reduction in symptoms, the prevention of adverse remodeling, and better cardiovascular outcomes.
• According to a study comparing AF management options with mortality in Asian Americans and Whites, Asian Americans were more likely to utilize a rate control strategy. They also had lower odds of using a rhythm control strategy such as ablations. The use of anticoagulants, on the other hand, had no significant difference between the races. Additionally, there was no discernible difference in the likelihood of all-cause mortality.

Use of Anticoagulants

•  Anticoagulant treatment is less likely in racial/ethnic minorities, contributing to their increased stroke and mortality rates. One study found a significant disparity in anticoagulant intake for stroke prevention between whites, blacks and Hispanics. Blacks had less intake than whites (black vs white: AHR 0.94; 95% CI 0.92-0.95; P < .001). Compared to whites, Hispanics had significantly less intake(Hispanic vs white: AHR 0.94; 95% CI 0.93-0.97; P < .001).

• A study of 111, 666 patients with atrial fibrillation treated from 2014 to 2018 found that Black and Asian patients were less likely to start anticoagulant medication. Of those who initiated anticoagulant treatment, Black, Hispanic, or American Indian/Alaska Native patients were less likely to start direct oral anticoagulant than whites.

INCIDENCE OF ATRIAL FIBRILLATION (AF)

Minorities Have Less Prevalence of AF Compared to Whites

• In the Atherosclerosis Risk in Communities Study, the incident rates of AF among whites were 8.1 per 1000 person-years and 5.8 per 1000 person-years among blacks.
• In the study of 47,417 Medicare beneficiaries with implanted cardiac devices, the incidence of AF among whites was 17.6 per 100 person-years and 12.2 per 100 person-years among blacks. Notably, the study had higher AF incidence rates due to the study only including individuals with cardiac conditions.
• African Americans and Hispanics have a lower incidence of AF than non-Hispanic whites while having a more significant burden of classic AF risk factors. The underdiagnosis of AF in minorities due to lower individual socioeconomic status and less access to healthcare could explain this racial paradox.
• In the Multi-Ethnic Study of Atherosclerosis, the incidence of AF was 49% lower for blacks than whites, 46% lower for Hispanics than whites, and 65% lower for Chinese than whites.

Among Latinx, Mexicans Have the Lowest Prevalence

• The prevalence of AF among non-Hispanic whites (NHWs) ranges from 2.3% to 3.4%. On the other hand, the overall AF prevalence in Hispanics/Latinos is approximately 1.0%.
• Among Latinos, the highest prevalence is in Hispanics of Dominican (1.9%) and Puerto Rican (2.5%) descent, with those of Mexican background having the lowest prevalence at 0.3%.

RACIAL DISPARITIES IN THE USE OF ABLATION FOR ATRIAL FIBRILLATION

Black and Latinx Disparity

• A 2021 study, “Racial/Ethnic and Socioeconomic Disparities in Management of Incident Paroxysmal Atrial Fibrillation,” concluded that catheter ablation use remained low in the Latinx and Black population.
• The number of Latinx and Blacks being treated using catheter ablation increased slightly from 2016 to 2019. Even with the slight increase less Latinx and Black patients were treated using catheter ablation than Whites and Asians.

Increased Use of Catheter Ablation

• Research revealed that the use of catheter ablation has increased from 2016 to 2019. However, catheter ablation use is higher in the Asian and White populations than the Black and Latinx populations.
• In 2016, less than 1% of the Asian patients were treated using catheter ablation. The percentage of Asian patients being treated then increased to more than 4% in 2019 to equal the number of white patients treated using catheter ablation.
•  
  Source

RESEARCH STRATEGY