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Risk of Atrial Fibrillation in Black Versus White Medicare Beneficiaries With Implanted Cardiac Devices
BACKGROUND: Black individuals in the United States experience higher rates of ischemic stroke than other racial groups but have lower rates of clinically apparent atrial fibrillation (AF). It is unclear whether blacks truly have less AF or simply more undiagnosed AF. METHODS AND RESULTS: We performe...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405685/ https://www.ncbi.nlm.nih.gov/pubmed/30741594 http://dx.doi.org/10.1161/JAHA.118.010661 |
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author | Chen, Monica L. Parikh, Neal S. Merkler, Alexander E. Kleindorfer, Dawn O. Bhave, Prashant D. Levitan, Emily B. Soliman, Elsayed Z. Kamel, Hooman |
author_facet | Chen, Monica L. Parikh, Neal S. Merkler, Alexander E. Kleindorfer, Dawn O. Bhave, Prashant D. Levitan, Emily B. Soliman, Elsayed Z. Kamel, Hooman |
author_sort | Chen, Monica L. |
collection | PubMed |
description | BACKGROUND: Black individuals in the United States experience higher rates of ischemic stroke than other racial groups but have lower rates of clinically apparent atrial fibrillation (AF). It is unclear whether blacks truly have less AF or simply more undiagnosed AF. METHODS AND RESULTS: We performed a retrospective cohort study using inpatient and outpatient claims from 2009 to 2015 for a 5% nationally representative sample of Medicare beneficiaries. We included patients aged ≥66 years with at least 1 documented Current Procedural Terminology code for interrogation of an implantable pacemaker, cardioverter‐defibrillator, or loop recorder and no documented history of AF, atrial flutter, or stroke before their first device interrogation. Kaplan–Meier statistics and Cox proportional hazards models were used to examine the association between black race and the composite outcome of AF or atrial flutter while adjusting for age, sex, and vascular risk factors. Among 47 417 eligible patients, the annual incidence of AF/atrial flutter was 12.2 (95% CI, 11.5–13.1) per 100 person‐years among blacks and 17.6 (95% CI, 17.4–17.9) per 100 person‐years among non‐black beneficiaries. After adjustment for confounders, black beneficiaries faced a lower hazard of AF/atrial flutter than non‐black beneficiaries (hazard ratio, 0.75; 95% CI, 0.70–0.80). Despite the lower risk of AF, black patients faced a higher hazard of ischemic stroke (hazard ratio, 1.37; 95% CI, 1.22–1.53). CONCLUSIONS: Among Medicare beneficiaries with implanted cardiac devices capable of detecting atrial rhythm, black patients had a lower incidence of AF despite a higher burden of vascular risk factors and a higher risk of stroke. |
format | Online Article Text |
id | pubmed-6405685 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-64056852019-03-19 Risk of Atrial Fibrillation in Black Versus White Medicare Beneficiaries With Implanted Cardiac Devices Chen, Monica L. Parikh, Neal S. Merkler, Alexander E. Kleindorfer, Dawn O. Bhave, Prashant D. Levitan, Emily B. Soliman, Elsayed Z. Kamel, Hooman J Am Heart Assoc Original Research BACKGROUND: Black individuals in the United States experience higher rates of ischemic stroke than other racial groups but have lower rates of clinically apparent atrial fibrillation (AF). It is unclear whether blacks truly have less AF or simply more undiagnosed AF. METHODS AND RESULTS: We performed a retrospective cohort study using inpatient and outpatient claims from 2009 to 2015 for a 5% nationally representative sample of Medicare beneficiaries. We included patients aged ≥66 years with at least 1 documented Current Procedural Terminology code for interrogation of an implantable pacemaker, cardioverter‐defibrillator, or loop recorder and no documented history of AF, atrial flutter, or stroke before their first device interrogation. Kaplan–Meier statistics and Cox proportional hazards models were used to examine the association between black race and the composite outcome of AF or atrial flutter while adjusting for age, sex, and vascular risk factors. Among 47 417 eligible patients, the annual incidence of AF/atrial flutter was 12.2 (95% CI, 11.5–13.1) per 100 person‐years among blacks and 17.6 (95% CI, 17.4–17.9) per 100 person‐years among non‐black beneficiaries. After adjustment for confounders, black beneficiaries faced a lower hazard of AF/atrial flutter than non‐black beneficiaries (hazard ratio, 0.75; 95% CI, 0.70–0.80). Despite the lower risk of AF, black patients faced a higher hazard of ischemic stroke (hazard ratio, 1.37; 95% CI, 1.22–1.53). CONCLUSIONS: Among Medicare beneficiaries with implanted cardiac devices capable of detecting atrial rhythm, black patients had a lower incidence of AF despite a higher burden of vascular risk factors and a higher risk of stroke. John Wiley and Sons Inc. 2019-02-12 /pmc/articles/PMC6405685/ /pubmed/30741594 http://dx.doi.org/10.1161/JAHA.118.010661 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Chen, Monica L. Parikh, Neal S. Merkler, Alexander E. Kleindorfer, Dawn O. Bhave, Prashant D. Levitan, Emily B. Soliman, Elsayed Z. Kamel, Hooman Risk of Atrial Fibrillation in Black Versus White Medicare Beneficiaries With Implanted Cardiac Devices |
title | Risk of Atrial Fibrillation in Black Versus White Medicare Beneficiaries With Implanted Cardiac Devices |
title_full | Risk of Atrial Fibrillation in Black Versus White Medicare Beneficiaries With Implanted Cardiac Devices |
title_fullStr | Risk of Atrial Fibrillation in Black Versus White Medicare Beneficiaries With Implanted Cardiac Devices |
title_full_unstemmed | Risk of Atrial Fibrillation in Black Versus White Medicare Beneficiaries With Implanted Cardiac Devices |
title_short | Risk of Atrial Fibrillation in Black Versus White Medicare Beneficiaries With Implanted Cardiac Devices |
title_sort | risk of atrial fibrillation in black versus white medicare beneficiaries with implanted cardiac devices |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405685/ https://www.ncbi.nlm.nih.gov/pubmed/30741594 http://dx.doi.org/10.1161/JAHA.118.010661 |
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