Abstract P022: Sex and Racial Differences in Cardiovascular Disease Risk in Patients With Atrial Fibrillation
Background: Women and African Americans with atrial fibrillation (AF) experience higher rates of stroke compared to men and white AF patients, respectively. However, sex and race differences for cardiovascular outcomes other than stroke have not been specifically evaluated in patients with AF.
Methods: We studied patients with AF in the Optum Clinformatics database between 2009 and 2015 with at least 6 months of enrollment before AF diagnosis. The Optum Clinformatics database includes medical and pharmacy claims and sociodemographic information on privately insured and Medicare Advantage enrollees throughout the US. Endpoints (hospitalizations for ischemic stroke, heart failure (HF), myocardial infarction (MI)) and covariates were defined using validated algorithms. Multivariable Cox models were used to study the association of race and sex with endpoints of interest.
Results: The analysis included 380,636 eligible participants (mean age 73, women 45%). Of them, 82% were white, 9% African American, 7% Hispanic and 2% Asian American. During a mean follow-up of 23 months, 7,235 suffered ischemic stroke, 17,258 HF, and 5,585 MI. Crude rates of ischemic stroke and HF were higher in women than men, while men had higher rates of MI than women (Table). African Americans and Hispanics had higher rates of all studied outcomes than whites and Asian Americans. In models including age, sex, race, education and CHA2DS2-VASc score, women had higher risk of ischemic stroke and lower risk of HF and MI compared to men. Compared to whites, African Americans had 1.4 times the rate of HF and stroke, and 1.1 times the rate of MI, while Asian Americans had 16% lower rates of HF. No major differences were observed between rates in whites and Hispanics (Table).
Conclusion: In a large insured population of patients with AF, we observed differences in rates of selected cardiovascular outcomes by sex and race. Additional research should explore the mechanisms underlying these differences and develop strategies to eliminate them.
Author Disclosures: A. Alonso: B. Research Grant; Significant; American Heart Association, National Institutes of Health. A. Chamberlain: None. P. Lutsey: None. R. MacLehose: None. F. Norby: None. W. O’Neal: None. L. Bengtson: A. Employment; Significant; Optum. L. Chen: None.
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2017 by American Heart Association, Inc.