Sex and Racial Differences in Cardiovascular Disease Risk in Patients with Atrial Fibrillation

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2019 Sep 5

PMID 31483839

Citations 11

Authors

Wesley T ONeal

Aniqa B Alam

Pratik B Sandesara

JNeka S Claxton

Richard F MacLehose

Lin Y Chen

Lindsay G S Bengtson

Alanna M Chamberlain

Faye L Norby

Pamela L Lutsey

Alvaro Alonso

Affiliations

Soon will be listed here.

Abstract

Background: Outcomes 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.

Methods: We 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.

Results: In 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.

Conclusions: We found sex and race/ethnic differences in risk of cardiovascular outcomes among AF patients, without evidence of improvement over time.

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References

Piccini J, Hammill B, Sinner M, Jensen P, Hernandez A, Heckbert S . Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007. Circ Cardiovasc Qual Outcomes. 2012; 5(1):85-93. PMC: 3332107. DOI: 10.1161/CIRCOUTCOMES.111.962688. View

Rodriguez C, Soliman E, Alonso A, Swett K, Okin P, Goff Jr D . Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis. Ann Epidemiol. 2014; 25(2):71-6, 76.e1. PMC: 4559265. DOI: 10.1016/j.annepidem.2014.11.024. View

Essien U, Holmes D, Jackson 2nd L, Fonarow G, Mahaffey K, Reiffel J . Association of Race/Ethnicity With Oral Anticoagulant Use in Patients With Atrial Fibrillation: Findings From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II. JAMA Cardiol. 2018; 3(12):1174-1182. PMC: 6583087. DOI: 10.1001/jamacardio.2018.3945. View

Patel N, Deshmukh A, Thakkar B, Coffey J, Agnihotri K, Patel A . Gender, Race, and Health Insurance Status in Patients Undergoing Catheter Ablation for Atrial Fibrillation. Am J Cardiol. 2016; 117(7):1117-26. DOI: 10.1016/j.amjcard.2016.01.040. View

Shobha N, Sylaja P, Kapral M, Fang J, Hill M . Differences in stroke outcome based on sex. Neurology. 2010; 74(9):767-71. PMC: 2836873. DOI: 10.1212/WNL.0b013e3181d5275c. View

Lip G, Nieuwlaat R, Pisters R, Lane D, Crijns H . Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2009; 137(2):263-72. DOI: 10.1378/chest.09-1584. View

B Sur N, Wang K, Di Tullio M, Gutierrez C, Dong C, Koch S . Disparities and Temporal Trends in the Use of Anticoagulation in Patients With Ischemic Stroke and Atrial Fibrillation. Stroke. 2019; 50(6):1452-1459. PMC: 6538423. DOI: 10.1161/STROKEAHA.118.023959. View

Wallace P, Shah N, Dennen T, Bleicher P, Bleicher P, Crown W . Optum Labs: building a novel node in the learning health care system. Health Aff (Millwood). 2014; 33(7):1187-94. DOI: 10.1377/hlthaff.2014.0038. View

Amponsah M, Benjamin E, Magnani J . Atrial Fibrillation and Race - A Contemporary Review. Curr Cardiovasc Risk Rep. 2013; 7(5). PMC: 3815541. DOI: 10.1007/s12170-013-0327-8. View

10.

Tamariz L, Rodriguez A, Palacio A, Li H, Myerburg R . Racial disparities in the use of catheter ablation for atrial fibrillation and flutter. Clin Cardiol. 2014; 37(12):733-7. PMC: 6647633. DOI: 10.1002/clc.22330. View

11.

Rodwin B, Salami J, Spatz E, Valero-Elizondo J, Virani S, Blankstein R . Variation in the Use of Warfarin and Direct Oral Anticoagulants in Atrial Fibrillation and Associated Cost Implications. Am J Med. 2018; 132(1):61-70.e1. DOI: 10.1016/j.amjmed.2018.09.026. View

12.

Movahed M, Khan M, Hashemzadeh M, Hashemzadeh M . Age adjusted nationwide trends in the incidence of all cause and ST elevation myocardial infarction associated cardiogenic shock based on gender and race in the United States. Cardiovasc Revasc Med. 2014; 16(1):2-5. DOI: 10.1016/j.carrev.2014.07.007. View

13.

Naser N, Kulic M, Dilic M, Dzubur A, Durak A, Pepic E . The Cumulative Incidence of Stroke, Myocardial infarction, Heart Failure and Sudden Cardiac Death in Patients with Atrial Fibrillation. Med Arch. 2017; 71(5):316-319. PMC: 5723164. DOI: 10.5455/medarh.2017.71.316-319. View

14.

Kummer B, Bhave P, Merkler A, Gialdini G, Okin P, Kamel H . Demographic Differences in Catheter Ablation After Hospital Presentation With Symptomatic Atrial Fibrillation. J Am Heart Assoc. 2015; 4(9):e002097. PMC: 4599497. DOI: 10.1161/JAHA.115.002097. View

15.

Berglund A, Schenck-Gustafsson K, von Euler M . Sex differences in the presentation of stroke. Maturitas. 2017; 99:47-50. DOI: 10.1016/j.maturitas.2017.02.007. View

16.

Marcus G, Alonso A, Peralta C, Lettre G, Vittinghoff E, Lubitz S . European ancestry as a risk factor for atrial fibrillation in African Americans. Circulation. 2010; 122(20):2009-15. PMC: 3058884. DOI: 10.1161/CIRCULATIONAHA.110.958306. View

17.

DeFrank J, Bowling J, Rimer B, Gierisch J, Skinner C . Triangulating differential nonresponse by race in a telephone survey. Prev Chronic Dis. 2007; 4(3):A60. PMC: 1955404. View

18.

Roberts J, Hu D, Heckbert S, Alonso A, Dewland T, Vittinghoff E . Genetic Investigation Into the Differential Risk of Atrial Fibrillation Among Black and White Individuals. JAMA Cardiol. 2016; 1(4):442-50. PMC: 5395094. DOI: 10.1001/jamacardio.2016.1185. View

19.

Staerk L, Sherer J, Ko D, Benjamin E, Helm R . Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. Circ Res. 2017; 120(9):1501-1517. PMC: 5500874. DOI: 10.1161/CIRCRESAHA.117.309732. View

20.

Chen M, Parikh N, Merkler A, Kleindorfer D, Bhave P, Levitan E . Risk of Atrial Fibrillation in Black Versus White Medicare Beneficiaries With Implanted Cardiac Devices. J Am Heart Assoc. 2019; 8(4):e010661. PMC: 6405685. DOI: 10.1161/JAHA.118.010661. View