Blacks with Atrial Fibrillation at Greater Risk for Adverse Outcomes

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New research from the University of Pittsburgh shows that black people with atrial fibrillation have nearly double the risk of stroke, heart failure, coronary heart disease and mortality from all causes than their white counterparts.

We knew blacks were likely to have an increased risk of stroke, but the findings for heart failure, CHD and mortality are novel and important. This should put the focus on improving prevention efforts.

Blacks with atrial fibrillation (AFib) have nearly double the risk than their white counterparts of stroke, heart failure, coronary heart disease (CHD) and mortality from all causes, according to a study published today in JAMA Cardiology.

The study, funded by a grant from the Doris Duke Foundation and led by Jared Magnani, M.D., associate professor of medicine, Division of Cardiology, University of Pittsburgh School of Medicine, and cardiologist at the UPMC Heart and Vascular Institute, analyzed data from the Atherosclerosis Risk in Communities (ARIC) Study to examine racial differences in adverse outcomes associated with AFib.

AFib is the most common heart rhythm problem in the U.S. It affects approximately 1 percent of the adult population and more than 5 percent of those 65 years old and older. It also is known to be strongly associated with increased risks of stroke, heart failure and mortality.

“We knew blacks were likely to have an increased risk of stroke, but the findings for heart failure, CHD and mortality are novel and important,” Dr. Magnani said. “This should put the focus on improving prevention efforts for adverse outcomes in blacks with atrial fibrillation, and drive further studies into the reasons behind why this is happening.”

The ARIC Study, sponsored by the National Heart, Lung, and Blood Institute, recruited 15,792 men and women, 45 to 64 years old, from four communities in the United States—Forsyth County, North Carolina; Jackson, Mississippi; the northwest suburbs of Minneapolis, Minnesota; and Washington County, Maryland. The community-based cohort was designed to investigate causes of atherosclerosis and cardiovascular disease, and included baseline examinations in 1986 and more than 20 years follow up.

“ARIC provided an opportunity to examine racial differences in outcomes related to atrial fibrillation. In general, most large studies of individuals with atrial fibrillation are predominantly of white participants,” Dr. Magnani said. “We know that atrial fibrillation is associated with adverse outcomes, but these data provided important insights into differences by race.”

After exclusions, 15,080 participants (8,290 women and 3,831 blacks) were included in the new analysis. Noteworthy racial differences at baseline examination included a body mass index of 27 percent for whites and 29.6 percent for blacks. Black participants also had a higher prevalence of hypertension and diabetes.

During analysis of the 20-year follow-up, 2,348 cases of AFib were identified—1,914 in whites with an incidence rate of 8.1 per 1,000 person-years, and 434 in blacks, with an incidence rate of 5.8 per 1,000 person-years. Researchers found that adverse outcomes in black participants were almost double that for whites.

The incidence rate of strokes in black participants was 21.4 compared to 10.2 in their white counterparts. For heart failure and CHD, the rate difference was almost two-fold higher in blacks than whites. Blacks also had a rate difference of 106 for mortality compared to 55.9 in whites.

Researchers also believe the results are enough to warrant an addition to the current guidelines for the management of patients with AFib developed by the American College of Cardiology, American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society to include the significant difference in adverse outcomes between blacks and whites with AFib.

Limitations of the study noted by researchers included that ARIC participants were from only four geographic regions and that the study is biracial. The researchers are careful to note that generalizability to other geographic regions or to other races and ethnicities may be limited.

“There needs to be further investigation,” said Dr. Magnani, who completed his research while at Boston University School of Medicine. “It’s going to be important to dissect the mechanisms behind why blacks with atrial fibrillation are highly more likely to have adverse outcomes than whites.”

The mission of the Doris Duke Charitable Foundation is to improve the quality of people's lives through grants supporting the performing arts, environmental conservation, medical research and child well-being, and through preservation of the cultural and environmental legacy of Doris Duke's properties.

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About the University of Pittsburgh School of Medicine
As one of the nation’s leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.

Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region’s economy. For more information about the School of Medicine, see .

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Lawerence Synett
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