Racial and Ethnic Differences in the Management of Atrial Fibrillation

Kamala P Tamirisa,Sana M Al-Khatib,Sanghamitra Mohanty,Janet K Han,Andrea Natale,Dhiraj Gupta,Andrea M Russo,Amin Al-Ahmad,Anne M Gillis,Kevin L Thomas

doi:10.1016/j.cjco.2021.09.004

Abstract

Atrial fibrillation (AF) is the most common clinical arrhythmia, and it results in adverse outcomes and increased healthcare costs. Racial and ethnic differences in AF management, although recognized, are poorly understood. This review summarizes racial differences in AF epidemiology, genetics, clinical presentation, and management. In addition, it highlights the underrepresentation of racial and ethnic populations in AF clinical trials, especially trials focused on stroke prevention. Specific strategies are proposed for future research and initiatives that have potential to eliminate racial and ethnic differences in the care of patients with AF. Addressing racial and ethnic disparities in healthcare access, enrollment in clinical trials, resource allocation, prevention, and management will likely narrow the gaps in the care and outcomes of racial and ethnic minorities suffering from AF.

Highlights

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide that is estimated to affect 37.6 million persons globally, and projected to increase by >60% by the year 2050.1 Currently, ~1 million people in Canada and 5.2 million in the United States have AF, with the number in the U.S predicted to increase to 12.1 million by the year 2030.2,3 In Asia, the overall AF prevalence is ~1% which is less than that in Western countries
This review summarizes racial and ethnic differences in AF epidemiology with a focus on the “AF Paradox” and ascertainment bias, genetics, clinical presentation and barriers to effective healthcare delivery by addressing each aspect of AF management including stroke prevention and rate and rhythm control modalities including ablation
By 2060, Hispanic patients will make up 29% of the U.S population, up from 17% in 2014; individuals with Black race alone or in combination with one or more other races will make up nearly 18% of the total population, up from 14% in 2014.12 Racial disparities in healthcare outcomes persist even after adjusting for socioeconomic factors.[105]

Summary

Disclosures

Han: Speaking honoraria, Abbott, Boston Scientific, Medtronic. Andrea Natale: Consultant for Abbott, Baylis, Biosense Webster, Boston Scientific, Biotronik and Medtronic. Dhiraj Gupta: Recipient for Institutional research grants: Biosense Webster, Boston Scientific, and Medtronic Advisory Board: Boston Scientific, Boehringer Ingelheim Speaking honoraria: Biosense Webster, Boston Scientific Andrea M. Russo: Research funding to Institution: BMS-Pfizer, Boston Scientific, Kestra, Medilynx Research Steering Committee: Boston Scientific, Medtronic Consultant: Biosense Webster, Medtronic, PaceMate. Amin Al-Ahmad: Consultant & Speaking honoraria for Biosense Webster, Abbott, Medtronic, and Boston Scientific Anne M. Funding Sources No funding was received for this manuscript

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