Racial differences in the prevalence and outcomes of atrial fibrillation among patients hospitalized with heart failure.
Abstract
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. METHODS AND 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.
Type
Journal articleSubject
anticoagulationatrial fibrillation
heart failure
racial disparity
risk factors
African Americans
Aged
Aged, 80 and over
Anticoagulants
Atrial Fibrillation
European Continental Ancestry Group
Female
Heart Failure
Hospitalization
Humans
Male
Middle Aged
Prevalence
Risk Factors
Treatment Outcome
Warfarin
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https://hdl.handle.net/10161/15017Published Version (Please cite this version)
10.1161/JAHA.113.000200Publication Info
Thomas, Kevin L; Piccini, Jonathan P; Liang, Li; Fonarow, Gregg C; Yancy, Clyde W;
Peterson, Eric D; ... Get With the Guidelines Steering Committee and Hospitals (2013). Racial differences in the prevalence and outcomes of atrial fibrillation among patients
hospitalized with heart failure. J Am Heart Assoc, 2(5). pp. e000200. 10.1161/JAHA.113.000200. Retrieved from https://hdl.handle.net/10161/15017.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Adrian Felipe Hernandez
Duke Health Cardiology Professor
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Jonathan Paul Piccini Sr.
Professor of Medicine
Jonathan P. Piccini, MD, MHS, FACC, FAHA, FHRS is a clinical cardiac electrophysiologist
and Associate Professor of Medicine with Tenure at Duke University Medical Center
and the Duke Clinical Research Institute. He is the Director of the Cardiac Electrophysiology
section at the Duke Heart Center. His focus is on the care of patients with atrial
fibrillation and complex arrhythmias, with particular emphasis on catheter ablation,
left atrial appendage occlusion, and lead extraction. His resear
Kevin Lindsey Thomas
Professor of Medicine
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