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Review
. 2023 Aug;66(5):1279-1290.
doi: 10.1007/s10840-022-01383-x. Epub 2022 Oct 13.

Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control

Sofia E Gomez  1 , Muhammad Fazal  1 , Julio C Nunes  2   3   4 , Shayena Shah  1 , Alexander C Perino  1 , Sanjiv M Narayan  1 , Kamala P Tamirisa  5 , Janet K Han  4   6 , Fatima Rodriguez  1 , Tina Baykaner  7
Affiliations
Review

Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control

Sofia E Gomez et al. J Interv Card Electrophysiol. 2023 Aug.

Abstract

Background: Atrial fibrillation (AF) affects around 6 million Americans. AF management involves pharmacologic therapy and/or interventional procedures to control rate and rhythm, as well as anticoagulation for stroke prevention. Different populations may respond differently to distinct management strategies. This review will describe disparities in rate and rhythm control and their impact on outcomes among women and historically underrepresented racial and/or ethnic groups.

Methods: This is a narrative review exploring the topic of sex and racial and/or ethnic disparities in rate and rhythm management of AF. We describe basic terminology, summarize AF epidemiology, discuss diversity in clinical research, and review landmark clinical trials.

Results: Despite having higher rates of traditional AF risk factors, Black and Hispanic adults have lower risk of AF than non-Hispanic White (NHW) patients, although those with AF experience more severe symptoms and report lower quality-of-life scores than NHW patients with AF. NHW patients receive antiarrhythmic drugs, cardioversions, and invasive therapies more frequently than Black and Hispanic patients. Women have lower rates of AF than men, but experience more severe symptoms, heart failure, stroke, and death after AF diagnosis. Women and people from diverse racial and ethnic backgrounds are inadequately represented in AF trials; prevalence findings may be a result of underdetection.

Conclusion: Race, ethnicity, and gender are social determinants of health that may impact the prevalence, evolution, and management of AF. This impact reflects differences in biology as well as disparities in treatment and representation in clinical trials.

Keywords: Atrial fibrillation; Disparities; Rhythm control.

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Figures

Fig. 1
Fig. 1
Minority involvement in atrial fibrillation clinical trials from Sarraju et al. [30]
Fig. 2
Fig. 2
Hazard ratios by sex in CABANA[44] and CASTLE-AF[45] trials showing a non-significant trend toward drug therapy being more favorable among women, with increased outcome variability
Fig. 3
Fig. 3
Racial, ethnic, and sex disparities in AF symptoms, clinical trial data, management (rhythm and rate control), and outcomes
See this image and copyright information in PMC

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