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CLINICAL RESEARCH: HEART FAILURE

Racial variation in the prevalence of atrial fibrillation among patients with heart failure

the Epidemiology, Practice, Outcomes, and Costs of Heart Failure (EPOCH) study

Bernice Ruo, MD^*, Angela M. Capra, MA, Nancy G. Jensvold, MPH and Alan S. Go, MD^,*

^* General Internal Medicine Section, San Francisco Veterans Administration Medical Center, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
Division of Research, Kaiser Permanente of Northern California, Oakland, California, USA
Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco, San Francisco, California, USA

Manuscript received February 3, 2003; revised manuscript received August 5, 2003, accepted September 17, 2003.

^* Reprint requests and correspondence: Dr. Alan S. Go, Division of Research, Kaiser Permanente of Northern California, 2000 Broadway St., 3rd Floor, Oakland, California 94612, USA.
Alan.S.Go{at}kp.org

OBJECTIVES: This study was designed to determine the association between race and atrial fibrillation (AF) among patients with heart failure (HF).

BACKGROUND: Atrial fibrillation is known to complicate HF, but whether its prevalence varies by race, and the reasons why, are not well understood.

METHODS: We identified adults hospitalized with confirmed HF within a large integrated healthcare delivery system. We obtained information on demographics, comorbidity, vital signs, medications, and left ventricular systolic function status. "Atrial fibrillation" was defined as AF or atrial flutter documented by electrocardiogram or prior physician-assigned diagnoses. We evaluated the independent relationship between race and AF using multivariable logistic regression.

RESULTS: Among 1,373 HF patients (223 African Americans, 1,150 Caucasians), the prevalence of AF was 36.9% (95% confidence interval [CI] 34.3% to 39.5%). Compared with Caucasians, African Americans were younger (mean age 67 vs. 74 years, p < 0.001) and more likely to have hypertension (86.6% vs. 77.7%, p < 0.01) and prior diagnosed HF (79.4% vs. 70.7%, p < 0.01). African Americans had less prior diagnosed coronary disease, revascularization, hypothyroidism, or valve replacement. Atrial fibrillation was much less prevalent in African Americans (19.7%) than Caucasians (38.3%, p < 0.001). After adjustment for risk factors for AF and other potential confounders, African Americans had 49% lower odds of AF (adjusted odds ratio 0.51, 95% CI 0.35 to 0.76).

CONCLUSIONS: In a contemporary HF cohort, AF was significantly less common among African Americans than among Caucasians. This variation was not explained by differences in traditional risk factors for AF, HF etiology and severity, and treatment.

Abbreviations and Acronyms   AF = atrial fibrillation   ARB = angiotensin II receptor blocker   ECG = electrocardiogram/electrocardiographic/ electrocardiography   HF = heart failure   LV = left ventricle/ventricular

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