Abstract 12978: Incident Atrial Fibrillation is Similar in Blacks and Whites With Congestive Heart Failure

Abstract

Introduction: Clinical studies have demonstrated that blacks have a lower prevalence and incidence of atrial fibrillation (AF) compared with whites. Given the strong biologic associations between AF and congestive heart failure (CHF), we hypothesized that the racial disparity for incident AF is attenuated in CHF patients. Methods: The University of Pennsylvania Atrial Fibrillation Free-Congestive Heart Failure (PAFF-CHF) Cohort is a large, multi-hospital retrospective cohort of individuals with clinical CHF and without AF at index visit. Baseline demographic and clinical parameters were obtained, and medical records were queried for incident outcomes. The primary outcome was incident AF, which was defined as a clinical or ECG diagnosis of AF on any follow up encounter. Results: Of 5,131 patients in PAFF-CHF, there were 2,037 blacks (40%) and 3,094 whites (60%). Median follow up time was 4.5 years (1.8, 5.9), with blacks having significantly longer follow up (4.7 v 4.2 yr, p < 0.001). During this follow-up, 851 subjects (16%) developed AF, with rates of 5.1 per 100 person years in whites and 4.9 per 100 person years in blacks (p = 0.8). Time independent risk factors for developing AF included male gender (OR 1.42 [95% CI 1.22 - 1.65], p < 0.001); LBBB on index ECG (1.32 [1.01 - 1.72], p = 0.04); and black race (OR 1.31 [1.13 - 1.52], p < 0.001). In a regression model of traditional risk factors for AF including age, gender, hypertension, coronary artery disease, diabetes, and renal insufficiency, black race remained an independent risk factor for AF (OR 1.45 [1.23 - 1.70], p < 0.001). Finally, time to event analysis showed no difference in freedom from AF and no difference in freedom from AF or death (Figure). Conclusions: In a large cohort of HF patients, incident AF was similar in blacks and whites. Although prior studies have indicated a low prevalence and incidence of AF in blacks compared with whites, the development of AF appears to be a common finding in both races after a diagnosis of CHF.