Sex and racial differences in cardiovascular disease risk in patients with atrial fibrillation.

Wesley T O’Neal,Aniqa B Alam,Lin Y Chen,Lindsay G S Bengtson,Alanna M Chamberlain,J’Neka S Claxton,Faye L Norby,Pamela L Lutsey,Pratik B Sandesara,Richard F Maclehose,Alvaro Alonso,Stefan Kiechl

doi:10.1371/journal.pone.0222147

Abstract

BackgroundOutcomes among atrial fibrillation (AF) patients may differ according to race/ethnicity and sex due to differences in biology, the prevalence of cardiovascular risk factors, and the use and effectiveness of AF treatments. We aimed to characterize patterns of cardiovascular risk across subgroups of AF patients by sex and race/ethnicity, since doing so may provide opportunities to identify interventions. We also evaluated whether these patterns changed over time.MethodsWe utilized administrative claims data from the Optum Clinformatics® Datamart database from 2009 to 2015. Patients with AF with ≥6 months of enrollment prior to the first non-valvular AF diagnosis were included in the analysis. Final analysis utilized Cox proportional hazard models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for cardiovascular outcomes stratified by sex and race/ethnicity. An additional analysis stratified outcomes by calendar year of AF diagnosis to evaluate changes in outcomes over time.ResultsIn a cohort of 380,636 AF patients, women had a higher risk of ischemic stroke [HR (95% CI): 1.25 (1.19, 1.31)] and lower risk of heart failure and myocardial infarction [HR (95% CI): 0.91 (0.88, 0.94) and 0.81 (0.77, 0.86), respectively)] compared to men. Black patients had elevated risk across all endpoints compared to whites, while Hispanics and Asian Americans showed no significant differences in any outcome compared to white patients. These sex and race/ethnic differences did not change over time.ConclusionsWe found sex and race/ethnic differences in risk of cardiovascular outcomes among AF patients, without evidence of improvement over time.

Highlights

Women and black patients with atrial fibrillation (AF) have been reported to have higher rates of stroke and other cardiovascular diseases compared with their male and white counterparts. [1, 2] prior studies have not examined these differences across cardiovascular outcomes in sufficiently large populations
In a cohort of 380,636 AF patients, women had a higher risk of ischemic stroke [hazard ratios (HR): 1.25 (1.19, 1.31)] and lower risk of heart failure and myocardial infarction [HR: 0.91 (0.88, 0.94) and 0.81 (0.77, 0.86), respectively)] compared to men
We found sex and race/ethnic differences in risk of cardiovascular outcomes among AF patients, without evidence of improvement over time

Summary

Introduction

Women and black patients with atrial fibrillation (AF) have been reported to have higher rates of stroke and other cardiovascular diseases compared with their male and white counterparts. [1, 2] prior studies have not examined these differences across cardiovascular outcomes in sufficiently large populations. [1, 2] prior studies have not examined these differences across cardiovascular outcomes in sufficiently large populations Whether these race/ethnic and sex differences have decreased or increased over time is unknown. Characterizing patterns of risk across subgroups of AF patients and their change over time can identify opportunities for intervention, leading to amelioration of existing sex and race/ethnic differences. The purpose of this analysis was to examine whether rates of cardiovascular outcomes among patients with AF varied by sex and race/ethnicity, and whether these rates changed over time using data from a large administrative claims database.

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