Racial variation in the prevalence of atrial fibrillation among patients with heart failure: the Epidemiology, Practice, Outcomes, and Costs of Heart Failure (EPOCH) study.
OBJECTIVE
This study was designed to determine the association between race and atrial fibrillation (AF) among patients with heart failure (HF).


BACKGROUND
Atrial fibrillation is known to complicate HF, but whether its prevalence varies by race, and the reasons why, are not well understood.


METHODS
We identified adults hospitalized with confirmed HF within a large integrated healthcare delivery system. We obtained information on demographics, comorbidity, vital signs, medications, and left ventricular systolic function status. "Atrial fibrillation" was defined as AF or atrial flutter documented by electrocardiogram or prior physician-assigned diagnoses. We evaluated the independent relationship between race and AF using multivariable logistic regression.


RESULTS
Among 1,373 HF patients (223 African Americans, 1,150 Caucasians), the prevalence of AF was 36.9% (95% confidence interval [CI] 34.3% to 39.5%). Compared with Caucasians, African Americans were younger (mean age 67 vs. 74 years, p < 0.001) and more likely to have hypertension (86.6% vs. 77.7%, p < 0.01) and prior diagnosed HF (79.4% vs. 70.7%, p < 0.01). African Americans had less prior diagnosed coronary disease, revascularization, hypothyroidism, or valve replacement. Atrial fibrillation was much less prevalent in African Americans (19.7%) than Caucasians (38.3%, p < 0.001). After adjustment for risk factors for AF and other potential confounders, African Americans had 49% lower odds of AF (adjusted odds ratio 0.51, 95% CI 0.35 to 0.76).


CONCLUSIONS
In a contemporary HF cohort, AF was significantly less common among African Americans than among Caucasians. This variation was not explained by differences in traditional risk factors for AF, HF etiology and severity, and treatment.
Ruo
Bernice
B
General Internal Medicine Section, San Francisco Veterans Administration Medical Center, San Francisco, California, USA.
Capra
Angela M
AM
Jensvold
Nancy G
NG
Go
Alan S
AS
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology / Q000208:ethnology*; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008329:Managed Care Programs / Q000706:statistics & numerical data; D015995:Prevalence; D044465:White People / Q000706:statistics & numerical data