Racial Differences in Atrial Fibrillation Epidemiology, Management, and Outcomes

AbstractPurpose of the reviewAtrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice and is associated with significant morbidity and healthcare cost. Most of the AF studies have predominantly included white population, with under-representation of minority population. In this review, we analyze the racial differences in epidemiology, disease awareness, risk factors, genetics, treatments, and outcomes of AF.Recent findingsAfrican Americans have a higher prevalence of established AF risk factors but lower incidence and prevalence of AF than non-Hispanic whites. There is also a significant racial and ethnic differences in the prevalence of AF-related symptoms and the detection and awareness of AF. Non-white patients are afforded decreased use of rhythm control treatment strategies and anticoagulation both with warfarin and NOACs for stroke prevention. They are less likely to receive catheter ablation (CA) of AF, compared with non-Hispanic whites. AF in the minority racial and ethnic groups carries increased morbidity and mortality compared with white groups, especially in the black individuals with AF, who have been shown to have a lower QoL compared with their white or Hispanic counterparts. Minorities experience stroke more frequently than the whites which is usually more severe and disabling.SummaryThere are significant racial differences in AF risk factors, manifestations, management, and outcomes. Recognition of these differences w...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research

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Purpose of review The association between atrial fibrillation and stroke is firmly established, and anticoagulation reduces stroke risk in patients with atrial fibrillation. However, the role of anticoagulation in very brief durations of atrial fibrillation (subclinical atrial fibrillation) is an area of controversy. Recent findings Stroke risk increases alongside burden of atrial fibrillation. Ongoing trials will clarify if 24 h or less of atrial fibrillation on extended monitoring necessitates lifelong anticoagulation. Trials examining empiric anticoagulation for individuals with ESUS did not demonstrate benefit o...
Source: Current Opinion in Neurology - Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Mitchell S.V. Elkind Source Type: research
Background Atrial fibrillation is common in the setting of acute coronary syndromes (ACS) although its impact on ACS remains controversial. Aim To describe in-hospital management of patients with atrial fibrillation and ACS evaluating the impact of atrial fibrillation on in-hospital and mid-term outcome. Methods We analysed the data of two prospective multicentre nationwide registries (IN-ACS Outcome and MANTRA) to assess clinical characteristics, management, and outcomes of patients with ACS and atrial fibrillation. Study outcomes included death from any cause and a composite end-point of death/re-infarction/strok...
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Research articles: Arrhythmias Source Type: research
Abstract Atrial fibrillation (AF) is the most common type of arrhythmia, which undermines cardiac function. Atrial fibrillation is a multi-facet malady and it may occur as a result of other diseases or it may trigger other problems. One of the main complications of AF is stroke due to the possibility of clot formation inside the atrium. However, the possibility of stroke occurrence due to the AF and the location from which an embolus dispatches are subject of debate. Another hypothesis about the embolus formation during AF is thrombus formation in aorta and carotid arteries, embolus detachment and its movement. To...
Source: Annals of Biomedical Engineering - Category: Biomedical Engineering Authors: Tags: Ann Biomed Eng Source Type: research
We examined frequency, clinical characteristics and AF‐related management and outcomes amongst this patient population.MethodsWe retrospectively studied consecutive probands with inherited cardiomyopathy (n=962) and inherited arrhythmia syndromes (n=195) evaluated between 2002 ‐2018.ResultsAF was observed in 5 ‐31% of patients, with the highest frequency in HCM. Age of AF onset was 45.8 ± 21.9 years in the inherited arrhythmia syndromes compared to 53.3 ± 15.3 years in the inherited cardiomyopathies, with 4 CPVT patients developing AF at median age of 20 years. Overall, 11% of patients with AF had a t r...
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ARTICLE Source Type: research
Authors: Khan AA, Thomas GN, Lip GYH, Shantsila A Abstract Atrial fibrillation is the most common heart arrhythmia and is associated with poor outcomes. The adverse effects of atrial fibrillation are mediated through multiple pathways, including endothelial dysfunction, as measured by flow-mediated dilatation. Flow-mediated dilatation has demonstrated endothelial dysfunction in several conditions and is associated with poor outcomes including mortality, yet can be improved with medical therapy. It is thus a useful tool in assessing endothelial function in patients.Endothelial dysfunction is present in patients with...
Source: Annals of Medicine - Category: Internal Medicine Tags: Ann Med Source Type: research
We examined the efficacy and safety of the 2 stage Hybrid AF ablation approach by analysing the largest series of this technique reported so far.MethodsThe approach aims to electrically isolate the left atrial posterior wall incorporating the pulmonary veins (‘box-set’pattern). An initial video-assisted thoracoscopic (VATS) epicardial ablation is followed after a minimum of 8 weeks by endocardial radiofrequency catheter ablation.ResultsOf 175 patients from 4 European cardiothoracic centers, who underwent the surgical (COBRA Fusion, AtriCure Inc) 1st stage ablation, 166 went on to complete 2nd stage cathete...
Source: IJC Heart and Vasculature - Category: Cardiology Source Type: research
This study aimed to compare outcomes according to arrhythmia management.MethodsAll hospitalisations for IART in ACHD patients were retrospectively identified from medico-administrative database from September 2006 to September 2016. Outcomes of patients with IART managed with direct-current cardioversion (DCCV) were compared with patients referred for catheter ablation (CA). Atrial arrhythmia recurrence, death, stroke and first admission for heart failure (HF) were analyzed during follow-up.ResultsNinety-one ACHD patients with IART (baseline median age 38 years [IQR 29-50], male 64%, 45% moderate CHD and 41% complex CHD) w...
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
Abstract Atrial fibrillation is the most common cardiac arrhythmia in western society affecting more than 35 million individuals worldwide annually. It is a common postoperative complication and may also occur spontaneously during general and local anesthesia administration. Aging, diabetes mellitus, hypertension, and cardiovascular diseases including cardiomyopathies, congenital cardiac anomalies, heart failure, myocardial ischemia, pericarditis, previous cardiac surgery, vascular disease, and valvular heart disease are some correlated factors. Beyond age, increased incidence of atrial fibrillation has been corre...
Source: Annals of Cardiac Anaesthesia - Category: Anesthesiology Authors: Tags: Ann Card Anaesth Source Type: research
Objective : Photoplethysmography (PPG) monitoring has been implemented in many portable and wearable devices we use daily for health and fitness tracking. Its simplicity and cost-effectiveness has enabled a variety of biomedical applications, such as continuous long-term monitoring of heart arrhythmias, fitness, and sleep tracking, and hydration monitoring. One major issue that can hinder PPG-based applications is movement artifacts, which can lead to false interpretations. In many implementations, noisy PPG signals are discarded. Misinterpreted or discarded PPG signals pose a problem in applications where the goal i...
Source: Physiological Measurement - Category: Physiology Authors: Source Type: research
AbstractBackgroundElectrical isolation of the left atrial appendage (LAA) may provide incremental benefits for arrhythmia management in patients undergoing radiofrequency ablation (RFA) for persistent atrial fibrillation (AF).ObjectiveThe aim of this study was to compare efficacy and safety of endocardial ablation and LAA exclusion with LARIAT device for electrical and mechanical exclusion of LAA.MethodsWe compared patients who underwent endocardial LAA isolation during index RFA for persistent AF and underwent a repeat RFA to patients who underwent LAA exclusion with LARIAT device followed by RFA for AF in this multicente...
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
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