Comparison of Frequency of Atrial Fibrillation in Blacks Versus Whites and the Utilization of Race in a Novel Risk Score
Section snippets
Methods
The National Inpatient Sample (NIS) is the largest inpatient, all-payer inclusive, and publicly available database in the United States and is sponsored by the Agency for Healthcare Research and Quality (AHRQ) in collaboration with Healthcare Cost and Utilization Project (HCUP).13 The database includes a randomly selected, 20% stratified sample of discharges representing 95% of all the United States community hospitals and academic medical centers excluding long-term, acute care hospitals, and
Results
Out of a total of 338 million inpatient discharges in the NIS database from 2003 to2013, 29.9 million (8.8%) had a diagnosis of AF at discharge, 11.3% of AF discharges were White, and 4.6% were Black (Figure 1). The incidence of AF per 1,000 persons/year was 7.1 in Whites and 3.6 in Blacks (p < 0.001).
In patients with a discharge diagnosis of AF, Whites had a higher percentage of patients > 74 years of age (64.1%) as compared with Blacks (41.8%, p < 0.01). Similarly, Blacks with AF had a higher
Discussion
There exists an ethnic paradox, with Blacks having a higher prevalence of traditional cardiovascular risk factors but a lower prevalence of AF as compared with Whites. For almost a decade, the AF ethnicity paradox has been described in the literature.8,12,20,21 In a systematic review, Ugowe et al.20 comprehensively summarized a number of large cohort studies that reported ethnic differences in the prevalence and incidence of AF. Our study reflects a higher prevalence (4.6 to 11.3%) of AF than
Conclusion
African Americans, despite having a significantly higher prevalence of traditional risk factors compared with Whites, have a substantially lower prevalence of AF. The factors responsible for this difference could be older age and survival bias, a stronger genetic predisposition, and differences in clinical course with Whites experiencing more persistent AF and symptomatic AF as compared with Blacks. The CHADSAVES risk score may help predict patients at risk for developing AF in hospital
Disclosures
Dr. Kenneth Ellenbogen has received honoraria, lecture honoraria, grant support from Medtronic, and Boston Scientific, honoraria and consulting from Abbott, and Biotronik. The remaining authors have no relevant conflicts of interest to disclose.
Author Contributions
Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Software; Supervision; Validation; Visualization; Roles/Writing - original draft; Writing - review & editing.
Gurukripa N. Kowlgi: Conceptualization; Data curation; Formal analysis; Investigation; Roles/Writing - original draft; Writing - review & editing. Sampath Gunda: Data curation; Formal analysis; Investigation; Methodology; Project administration;
Declaration of Competing Interests
The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported in this study.
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