Race, Ethnicity Linked to Divergent Outcomes in AF
In a cohort of 157,332 in the Veterans Health Administration with atrial fibrillation (AF), Black patients had a 14% higher risk for stroke than White patients, but Black, Asian, and Hispanic patients were less likely than White patients to die from stroke.
METHODOLOGY:
Researchers identified 157,332 patients in the Veterans Health Administration with incident AF (mean age, 72.9 ± 10.5 years, 97.8% men) from January 1, 2014, to December 31, 2021, with follow-up through May 31, 2022.
The study's independent variables were race and ethnicity.
The primary outcomes were the incidence of stroke and mortality from any cause. Cox proportional hazard models were used to assess associations between race and ethnicity and patient outcomes.
TAKEAWAY:
Overall, 22,628 patients (14.7%) experienced a stroke (46.3 per 1,000 person-years) during the study period, with Black patients showing a higher risk for the event (adjusted hazard ratio [AHR], 1.14; 95% CI, 1.09-1.20) than White patients. No significant differences were observed between White patients and American Indian/Alaska Native, Asian, or Hispanic patients.
Overall, 52,288 patients (33.2%) died (96.1 per 1,000 person-years), with Asian (AHR, 0.85; 95% CI, 0.78-0.93), Black (AHR, 0.92; 95% CI, 0.89-0.95), and Hispanic (AHR, 0.82; 95% CI, 0.77-0.87) patients showing a lower risk for death than White patients.
Among patients with stroke, mortality rates were higher for racial and ethnic minoritized groups, while those without stroke showed lower mortality rates for Asian, Black, and Hispanic patients compared to White patients.
IN PRACTICE:
'Our findings of higher rates of stroke in Black patients, even when controlling for anticoagulant use, suggest that there are other mechanisms by which stroke prevention must be addressed in ongoing VA quality improvement efforts for AF. These include improving equitable access to all AF treatment strategies beyond anticoagulation, including rhythm control agents and therapeutic procedures such as cardiac ablation, for which notable disparities have been observed,' the researchers reported. 'Furthermore, our observation that the magnitude of the association between race and stroke decreased with the addition of socioeconomic markers in our stepwise modeling suggests that addressing social factors and structural determinants beyond the health system may improve downstream AF outcomes.'
SOURCE:
The study was led by Utibe R. Essien, MD, MPH, of the David Geffen School of Medicine at the University of California, Los Angeles, and Leslie R.M. Hausmann, PhD, MS, of the Center for Health Equity Research and Promotion at the VA Pittsburgh Healthcare System, Pittsburgh. It was published online in JACC: Advances .
LIMITATIONS:
The study primarily included men receiving care within the Veterans Health Administration, limiting crossover to non-VA settings or practices with larger proportions of female patients. Stroke outcomes were identified solely through VA data. The analysis lacked data on specific cause of death, preventing an analysis of cardiovascular mortality.
DISCLOSURES:
The study received funding from the Veterans Affairs Health Services Research and Development Division and the American Heart Association Amos Medical Faculty Development Program Award. The funders had no role in the study design, data collection, and analysis. The authors reported having no relationships relevant to the paper's contents.
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