Racial differences in the prevalence and outcomes of atrial fibrillation among patients hospitalized with heart failure.
BACKGROUND
The intersection of heart failure (HF) and atrial fibrillation (AF) is common, but the burden of AF among black patients with HF is poorly characterized. We sought to determine the prevalence of AF, characteristics, in-hospital outcomes, and warfarin use associated with AF in patients hospitalized with HF as a function of race.


RESULTS
We analyzed data on 135 494 hospitalizations from January 2006 through January 2012 at 276 hospitals participating in the American Heart Association's Get With The Guidelines HF Program. Multivariable logistic regression models using generalized estimating equations approach for risk-adjusted comparison of AF prevalence, in-hospital outcomes, and warfarin use. In this HF population, 53 389 (39.4%) had AF. Black patients had markedly less AF than white patients (20.8% versus 44.8%, P < 0.001). Adjusting for risk factors and hospital characteristics, black race was associated with significantly lower odds of AF (adjusted odds ratio 0.52, 95% CI 0.48 to 0.55, P < 0.0001). There were no racial differences in in-hospital mortality; however, black patients had a longer length of stay relative to white patients. Black patients compared with white patients with AF were less likely to be discharged on warfarin (adjusted odds ratio 0.76, 95% CI 0.69 to 0.85, P < 0.001).


CONCLUSIONS
Despite having many risk factors for AF, black patients, relative to white patients hospitalized for HF, had a lower prevalence of AF and lower prescription of guideline-recommended warfarin therapy.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
Kevin L
KL
Thomas
Jonathan P
JP
Piccini
Li
L
Liang
Gregg C
GC
Fonarow
Clyde W
CW
Yancy
Eric D
ED
Peterson
Adrian F
AF
Hernandez
D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000150:complications; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use; D044465:White People
D000925:Anticoagulants; D014859:Warfarin
anticoagulation; atrial fibrillation; heart failure; racial disparity; risk factors