The prevalence of atrial fibrillation on 48-hour ambulatory electrocardiography in African Americans compared to Whites: The Atherosclerosis Risk in Communities (ARIC) study

• Type of Material: Article
• Authors: Laura R. Loehr, University of North Carolina; Elsayed Z. Soliman, Wake Forest University; Anna K. Poon, University of North Carolina; David Couper, University of North Carolina; Lin Yee Chen, University of Minnesota; Thomas H. Mosley, University of Mississippi; Lynne E. Wagenknecht, Wake Forest University; Eric A. Whitsel, University of North Carolina; Alvaro Alonso, Emory University; Lisa Wruck, Duke Clinical Research Institute; Gerardo Heiss, University of North Carolina
• Language: English
• Date: 2019-10-01
• Publisher: MOSBY-ELSEVIER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 The Authors. Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ahj.2019.06.017
• Title of Journal or Parent Work: AMERICAN HEART JOURNAL
• Volume: 216
• Start Page: 1
• End Page: 8
• Grant/Funding Information: Research reported here was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health under award number R01HL116900. The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under contract nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I. Additional support was provided by American Heart Association grant 16EIA26410001 (Alonso), and from National Heart, Lung, and Blood Institute grants R01HL126637 and R01HL141288 (Chen). The authors thank the staff and participants of the ARIC study for their important contributions.
• Keywords: Life Sciences & Biomedicine; ETHNIC-DIFFERENCES; OLDER-ADULTS; Cardiac & Cardiovascular Systems; EPIDEMIOLOGY; Science & Technology; Cardiovascular System & Cardiology; WOMEN; CARDIOVASCULAR-DISEASE; HEART-FAILURE; RACIAL-DIFFERENCES; PREVENTION; FOLLOW-UP; RHYTHM-MANAGEMENT

Abstract

Background: A lower prevalence of atrial fibrillation (AF), but paradoxically higher burden of cardiovascular disease risk factors, has been observed among African Americans compared to Whites in studies of AF identified by mostly 12-lead electrocardiograms (ECGs) and clinically. Methods: We performed 48-hour ambulatory electrocardiography (aECG) in a biracial sample of 1,193 participants in the Atherosclerosis Risk in Communities (ARIC) (mean age = 78 years, 62% African Americans, 64% female). Atrial fibrillation was identified from aECG, study visit ECGs, and discharge codes from cohort hospitalizations. We used covariate-adjusted logistic regression to estimate prevalence odds ratios (ORs) for AF in African Americans versus Whites, with adjustment for sampling and nonresponse. Results: African Americans were more likely than Whites to have hypertension and diabetes but less likely to have coronary heart disease. The prevalence of AF detected by aECG or ARIC study ECG (adjusted for age and coronary heart disease) was lower in African Americans than Whites (2.7% vs 5.0%). White men had a higher (although not significant) AF prevalence of 7.8% compared to the other race and gender groups at 2.3%-2.8%. The adjusted OR for AF was 0.49 (0.24-0.99) comparing African Americans to Whites. Findings were similar when AF was defined to include prior AF hospitalizations (OR = 0.42, 0.25-0.72). There were no significant differences by race for asymptomatic or paroxysmal AF. Conclusions: Atrial fibrillation was less prevalent in African American than white older adults, regardless of detection method. Although overall detection of new AF cases with aECG was low, future studies should consider longer-term monitoring to characterize AF by race.