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Published on: July 20, 2022
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Racial Differences in Device-Detected Incident Atrial Fibrillation
Jack A Goergen1, Graham Peigh1, Nathan Varberg2
1Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
JACC. Clinical Electrophysiology
|December 21, 2024
Summary
Black and White individuals show similar atrial fibrillation (AF) risk when detected by cardiac implantable electronic devices (CIEDs). This suggests prior disparities may stem from underdetection, not inherent risk differences, for AF in Black populations.
Area of Science:
- Cardiology
- Electrophysiology
- Public Health
Background:
- Previous studies indicated lower atrial fibrillation (AF) incidence in Black individuals compared to White individuals.
- This disparity may be attributed to underdetection of AF in Black populations.
- The persistence of this trend with advanced AF diagnostic methods remains understudied.
Purpose of the Study:
- To compare the incidence of atrial fibrillation (AF) between Black and White individuals.
- To utilize cardiac implantable electronic devices (CIEDs) for highly sensitive AF detection.
- To investigate racial differences in AF risk using modern diagnostic technology.
Main Methods:
- Retrospective observational study of Black and White patients with CIEDs implanted between 2007 and 2019.
- Exclusion of patients with insertable cardiac monitors, insufficient monitoring, or prior AF diagnosis.
- Primary endpoint: adjusted incidence of device-detected AF.
Main Results:
- Analysis included 88,427 patients (35,143 with device-detected AF).
- Crude AF incidence was higher in White individuals (27.95/100 person-years) vs. Black individuals (24.86/100 person-years).
- Adjusted analysis revealed similar AF hazard between racial groups (HR: 1.02; 95% CI: 0.98-1.06).
- Subgroup analysis showed differing hazards based on CIED type: higher AF risk for White individuals with pacemakers, and for Black individuals with implantable cardioverter-defibrillators.
Conclusions:
- The adjusted hazard for atrial fibrillation (AF) is comparable between Black and White individuals when detected by CIEDs.
- This finding supports the hypothesis that underdetection may explain previously observed racial disparities in AF incidence.
- Further research into CIED type-specific risks is warranted.
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