TY - JOUR
T1 - Racial/ethnic differences in atrial fibrillation symptoms, treatment patterns, and outcomes
T2 - Insights from Outcomes Registry for Better Informed Treatment for Atrial Fibrillation Registry
AU - Outcomes Registry for Better Informed Treatment for Atrial Fibrillation (ORBIT-AF) Registry
AU - Golwala, Harsh
AU - Jackson, Larry R.
AU - Simon, Da Juanicia N.
AU - Piccini, Jonathan P.
AU - Gersh, Bernard
AU - Go, Alan S.
AU - Hylek, Elaine M.
AU - Kowey, Peter R.
AU - Mahaffey, Kenneth W.
AU - Thomas, Laine
AU - Fonarow, Gregg C.
AU - Peterson, Eric D.
AU - Thomas, Kevin L.
N1 - Funding Information:
Dr Thomas reports being a consultant for Pfizer and Bristol Myers Squibb and receives research support from Boston Scientific. Dr Gersh reports being on data safety and monitoring board for Baxter Healthcare Corporation, Cardiovascular Research Foundation, St Jude Medical, Boston Scientific, member of steering committee for Medtronic, and member of executive committee for Ortho-McNeil Janssen Scientific Affairs. Dr Fonarow reports research support from Agency for Healthcare Research and Quality and consultancy fees from Janssen and Medtronic. Dr Kowey reports serving as a consultant to or on the advisory board of Johnson & Johnson, Daiichi Sankyo, Sanofi, Boehringer Ingelheim, Merck, Bristol Myers Squibb, and Portola. Financial disclosures for Dr Mahaffey before August 1, 2013, can be viewed at https://www.dcri.org/about-us/conflict-of-interest/Mahaffey-COI_2011-2013.pdf ; disclosures after August 1, 2013, can be viewed at http://med.stanford.edu/profiles/kenneth_mahaffey . Dr Peterson reports receiving research grants from the American Heart Association, the American College of Cardiology, Janssen Pharmaceutical Products, Eli Lilly & Co, and the Society of Thoracic Surgeons as well as serving as a consultant to or on the advisory board of Merck & Co, Boehringer Ingelheim, Genentech, Sanofi-Aventis, and Janssen Pharmaceutical Products. Dr Piccini reports receiving research grants from Johnson & Johnson/Janssen Pharmaceuticals and Boston Scientific Corp as well as other research support from Johnson & Johnson/Janssen Pharmaceuticals and consultant/advisory board fees from Forest Laboratories, Inc; Medtronic Inc; and Johnson & Johnson/Janssen Pharmaceuticals. Dr Hylek reports honoraria for consultancy from Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Janssen, Medtronic, and Pfizer. The other authors report no disclosures.
Publisher Copyright:
© 2016 The Authors.
PY - 2016/4
Y1 - 2016/4
N2 - Background Significant racial/ethnic differences exist in the incidence of atrial fibrillation (AF). However, less is known about racial/ethnic differences in quality of life (QoL), treatment, and outcomes associated with AF. Methods Using data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we compared clinical characteristics, QoL, management strategies, and long-term outcomes associated with AF among various racial/ethnic groups. Results We analyzed 9,542 participants with AF (mean age 74 ± 11 years, 43% women, 91% white, 5% black, 4% Hispanic) from 174 centers. Compared with AF patients identified as white race, patients identified as Hispanic ethnicity and those identified as black race were younger, were more often women, and had more cardiac and noncardiac comorbidities. Black patients were more symptomatic with worse QoL and were less likely to be treated with a rhythm control strategy than other racial/ethnic groups. There were no significant racial/ethnic differences in CHA2DS2-VASc stroke or ATRIA bleeding risk scores and rates of oral anticoagulation use were similar. However, racial and ethnic minority populations treated with warfarin spent a lower median time in therapeutic range of international normalized ratio (59% blacks vs 68% whites vs 62% Hispanics, P <.0001). There was no difference in long-term outcomes associated with AF between the 3 groups at a median follow-up of 2.1 years. Conclusion Relative to white and Hispanic patients, black patients with AF had more symptoms, were less likely to receive rhythm control interventions, and had lower quality of warfarin management. Despite these differences, clinical events at 2 years were similar by race and ethnicity.
AB - Background Significant racial/ethnic differences exist in the incidence of atrial fibrillation (AF). However, less is known about racial/ethnic differences in quality of life (QoL), treatment, and outcomes associated with AF. Methods Using data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we compared clinical characteristics, QoL, management strategies, and long-term outcomes associated with AF among various racial/ethnic groups. Results We analyzed 9,542 participants with AF (mean age 74 ± 11 years, 43% women, 91% white, 5% black, 4% Hispanic) from 174 centers. Compared with AF patients identified as white race, patients identified as Hispanic ethnicity and those identified as black race were younger, were more often women, and had more cardiac and noncardiac comorbidities. Black patients were more symptomatic with worse QoL and were less likely to be treated with a rhythm control strategy than other racial/ethnic groups. There were no significant racial/ethnic differences in CHA2DS2-VASc stroke or ATRIA bleeding risk scores and rates of oral anticoagulation use were similar. However, racial and ethnic minority populations treated with warfarin spent a lower median time in therapeutic range of international normalized ratio (59% blacks vs 68% whites vs 62% Hispanics, P <.0001). There was no difference in long-term outcomes associated with AF between the 3 groups at a median follow-up of 2.1 years. Conclusion Relative to white and Hispanic patients, black patients with AF had more symptoms, were less likely to receive rhythm control interventions, and had lower quality of warfarin management. Despite these differences, clinical events at 2 years were similar by race and ethnicity.
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U2 - 10.1016/j.ahj.2015.10.028
DO - 10.1016/j.ahj.2015.10.028
M3 - Article
C2 - 26995367
AN - SCOPUS:84962486415
VL - 174
SP - 29
EP - 36
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
ER -