Atrial Fibrillation in Tribal and Non-tribal Populations: A Comparative Analysis From Eastern India

Background Atrial fibrillation (AF) is an increasingly prevalent arrhythmia in India, where rheumatic heart disease and cardiometabolic etiologies coexist. This study compared the demographic profile, clinical presentation, associated clinical conditions, echocardiographic characteristics, thromboembolic risk, and anticoagulation practices between tribal patients and non-tribal patients in Eastern India. Methods This retrospective hospital-based cross-sectional study included 364 consecutive adult patients with AF (106 tribal and 258 non-tribal patients) admitted between January 2022 and December 2024. Clinical, electrocardiographic, echocardiographic, and treatment data were extracted from hospital records. Continuous variables were compared using Welch's t-test and categorical variables using Pearson's chi-square test. Results Tribal patients more frequently presented with first-diagnosed AF (81/106, 76.4% vs. 153/258, 59.3%; p = 0.002), higher ventricular rates (112.6 ± 25.1 vs. 102.3 ± 19.6 beats/min; p < 0.001), lower left ventricular ejection fraction (46.0 ± 11.7% vs. 51.0 ± 10.5%; p < 0.001), and more heart failure symptoms at presentation (27/106, 25.4% vs. 41/258, 15.9%; p = 0.033). Lifestyle-related risk factors were significantly more prevalent among tribal patients (79/106, 74.5% vs. 137/258, 53.1%; p < 0.001). Conversely, non-tribal patients had a higher prevalence of cardiometabolic disorders (168/258, 65.1% vs. 43/106, 40.6%; p < 0.001), ischemic cardiovascular disease (69/258, 26.7% vs. 18/106, 17.0%; p = 0.047), chronic kidney disease (93/258, 36.0% vs. 25/106, 23.6%; p = 0.021), higher CHA₂DS₂-VASc scores (2.38 ± 1.66 vs. 1.86 ± 1.45; p = 0.004), and a greater proportion meeting criteria for long-term oral anticoagulation (192/258, 74.4% vs. 67/106, 63.2%; p = 0.032). Rheumatic heart disease, heart failure, left atrial thrombus, ischemic stroke, and anticoagulant prescribing patterns were comparable between the two groups. Conclusions Tribal patients with AF had more first-diagnosed AF, higher ventricular rates, lower left ventricular systolic function, and greater lifestyle-related risk factors, whereas non-tribal patients had greater cardiometabolic and thromboembolic risk. These findings demonstrate differences in the clinical presentation and risk profile of AF within this hospital-based cohort and highlight the need for population-specific strategies to improve AF detection, prevention, and management in Eastern India.