Comparison of frequency of atrial fibrillation after coronary artery bypass grafting in African Americans versus European Americans

Racial Differences in the Prevalence and Outcomes of Atrial Fibrillation in Patients Hospitalized With Heart Failure

Previous research has shown that roughly 15% to 30% of those with heart failure (HF) develop atrial fibrillation (AF). Although studies have shown variations in the incidence of AF in patients with HF, there has been no evidence of mortality differences by race. The purpose of this study was to assess AF prevalence and inhospital mortality in patients with HF among different racial groups in the United States. Using the National Inpatient Sample registry, the largest publicly available all-payer inpatient care database representing >95% of the US inpatient population, we analyzed subjects hospitalized with a primary diagnosis of HF from 2001 to 2011 (n = 11,485,673) using the International Classification of Diseases, Ninth Edition (ICD 9) codes 428.0-0.1, 428.20-0.23, 428.30-0.33, 428.40-0.43, and 428.9; patients with AF were identified using the ICD 9 code 427.31. We assessed prevalence and mortality among racial groups. Using logistic regression, we examined odds of mortality adjusted for demographics and co-morbidity using Elixhauser co-morbidity index. We also examined utilization of procedures by race. Of the 11,485,673 patients hospitalized with HF in our study, 3,939,129 (34%) had AF. Patients with HF and AF had greater inhospital mortality compared with those without AF (4.6% vs 3.3% respectively, p <0.0001). Additionally, black, Hispanic, Asian, and white patients with HF and AF had a 24%, 17%, 13%, and 6% higher mortality, respectively, than if they did not have AF. Among patients with HF and AF, minority racial groups had underutilization of catheter ablation and cardioversion compared with white patients. In conclusion, minority patients with HF and AF had a disproportionately higher risk of inpatient death compared with white patients with HF. We also found a significant underutilization of cardioversion and catheter ablation in minority racial groups compared with white patients.

Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis

PURPOSE

We studied incident atrial fibrillation (AF) in the prospective community-based Multi-Ethnic Study of Atherosclerosis (MESA). Reportedly, non-Hispanic blacks (NHBs) have a lower AF burden compared with their non-Hispanic white (NHW) counterparts. Information on the epidemiology of AF in Hispanic and Asian populations is much more limited.

METHODS

We excluded participants with a history of AF at enrollment. A total of 6721 MESA participants were monitored for the first AF event ascertained according to hospital discharge International Classification of Diseases, Ninth Revision, codes. Age- and sex-adjusted incidence rates (IRs) of AF were calculated per 1000 person-years of observation. IR ratios were calculated using NHWs as the reference group. Age- and sex-adjusted population attributable fractions (PAFs) of established modifiable AF risk factors were ascertained.

RESULTS

In the MESA cohort, 47.2% was male; at baseline, 25.7% had hypertension; 12.5% had diabetes. Three hundred five incident hospitalized AF events occurred over a mean follow-up of 7.3 years. Age- and sex-adjusted IRs and IR ratios showed that overall AF incidence was significantly lower among Hispanics, NHBs and Chinese compared with NHWs (all P < .001). Among participants 65 years of age or greater, Hispanics, Chinese, and blacks had significantly lower AF incidence than NHWs (all P ≤ .01), but IRs were similar among participants under age 65 years. The PAF for smoking was 27% among NHBs but lower among other race-ethnic groups. Among NHWs, the PAF for hypertension was 22.2%, but this was higher among NHBs (33.1%), Chinese (46.3%), and Hispanics (43.9%).

CONCLUSIONS

Overall, the incidence of hospitalized AF was significantly lower in Hispanics, NHBs, and Chinese than in NHWs. A larger proportion of AF events appear to be attributable to hypertension among nonwhite populations compared with NHWs.

Anticoagulation strategies for the management of postoperative atrial fibrillation

Patients undergoing thoracic and cardiac procedures are at the highest risk for postoperative atrial fibrillation (POAF). POAF is associated with poor short-term and long-term outcomes, including high rates of early and late stroke, and late mortality. Patients with POAF that persists for longer than 48 hours should be anticoagulated on warfarin. Three new oral anticoagulants are available for the treatment of nonvalvular atrial fibrillation and have been found to be as efficacious or superior to warfarin in the prevention of stroke in high-risk patients, with similar to lower rates of major bleeding, and lower rates of intracranial hemorrhage.

The impact of race and postoperative atrial fibrillation on operative mortality after elective coronary artery bypass grafting

OBJECTIVE

Black patients are less likely to develop postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) than whites. However, the influence of race and POAF on operative mortality has not been examined. The objective of this study was to determine the influence of race and POAF on operative mortality after CABG.

METHODS

Patients undergoing elective CABG between 1992 and 2011 were included. Operative mortality was compared between patients with and those without new-onset POAF by race. Relative risk (RR) and 95% confidence intervals (CI) were computed using Poisson (robust variance estimates) and log-binomial regression models.

RESULTS

A total of 1215 (23%) patients developed POAF (white n=1060; black n=155) following CABG (N=5387). Operative mortality differed by POAF status within race category (white POAF: adjusted RR=1.4, 95% CI=0.86-2.2; black POAF: adjusted RR=5.0, 95% CI=1.9-13; Pinteraction=0.0016). Black POAF patients had a 2-fold increased risk of operative death compared with white POAF patients (Padjusted=0.052).

CONCLUSION

POAF was observed to be a stronger predictor of operative mortality in black compared with white patients undergoing elective CABG.

Impact of race and postoperative atrial fibrillation on long-term survival after coronary artery bypass grafting

BACKGROUND AND AIM

Postoperative atrial fibrillation (POAF) is a known predictor of in-hospital morbidity and short-term survival after coronary artery bypass grafting (CABG). The impact of race and long-term survival has not been examined in this population. We aimed to examine the influence of these factors on long-term survival in patients undergoing CABG.

METHODS

Patients undergoing first-time, isolated CABG between 1992 and 2011 were included in this study. Long-term survival was compared in patients with and without POAF and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model.

RESULTS

A total of 2,907 (22%) patients developed POAF (black n=370; white n=2,537) following CABG (N=13,165). Median follow-up for study participants was 8.2 years. Long-term survival after CABG differed by POAF status and race (no POAF: HR=1.0; white POAF: adjusted HR=1.1, 95% CI=1.06-1.2; black POAF: adjusted HR=1.4, 95% CI=1.2-1.6; pTrend=0.0002). lack POAF patients also died sooner after surgery than their white counterparts (adjusted HR=1.2, 95% CI=1.02-1.4).

CONCLUSION

Black race was a statistically significant predictor of decreased survival among POAF patients after CABG. This finding provides useful outcome information for surgeons and their patients.

Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery

BACKGROUND

Although major noncardiac surgery is common, few large-scale studies have examined the incidence and consequences of post-operative atrial fibrillation (POAF) in this population. We sought to define the incidence of POAF and its impact on outcomes after major noncardiac surgery.

METHODS

Using administrative data, we retrospectively reviewed the hospital course of adults who underwent major noncardiac surgery at 375 US hospitals over a 1-year period. Clinically significant POAF was defined as atrial fibrillation occurring during hospitalization that necessitated therapy.

RESULTS

Of 370,447 patients, 10,957 (3.0%) developed clinically significant POAF while hospitalized. Of patients with POAF, 7,355 (67%) appeared to have pre-existing atrial fibrillation and 3,602 (33%) had newly diagnosed atrial fibrillation. Black patients had a lower risk of POAF (adjusted odds ratio, 0.53; 95% CI, 0.48-0.59; P < .001). Patients with POAF had higher mortality (adjusted odds ratio, 1.72; 95% CI, 1.59-1.86; P < .001), markedly longer length of stay (adjusted relative difference, +24.0%; 95% CI, +21.5% to +26.5%; P < .001), and higher costs (adjusted difference, +$4,177; 95% CI, +$3,764 to +$4,590; P < .001). These findings did not differ by whether POAF was a recurrence of pre-existing atrial fibrillation, or a new diagnosis.

CONCLUSION

POAF following noncardiac surgery is not uncommon and is associated with increased mortality and cost. Our study identifies risk factors for POAF, which appear to include race. Strategies are needed to not only prevent new POAF, but also improve management of patients with pre-existing atrial fibrillation.

Postoperative Atrial Fibrillation: Year 2011 Review of Predictive and Preventative Factors of Atrial Fibrillation Post Cardiac Surgery

Background: Post cardiac surgery atrial fibrillation is common after cardiac surgery. Despite the advances in medical and surgical treatment, its incidence remains high and unchanged for decades. The aim of this review was to summarize studies published in 2011 on identifying factors, prevention strategies, treatment and effect of post operative atrial fibrillation (POAF) on the outcome after cardiac surgery. Methods: A review was performed on Medline, Embase and Chocrane on all of the English-language, peer-reviewed published clinical studies on POAF; studies investigating the mechanism of developing POAF, prevention, treatment and outcome were all included and analyzed. Case reports, studies on persistent/preoperative atrial fibrillation (AF), POAF after cardiac transplant, congenital cases and nonclinical studies were all excluded. We have also valuated these studies based on the type of the study, their originality, impact factor of the journal and their limitations. Results: Overall 62 studies were reviewed and analyzed; 26 on POAF predictive factors, 31 on preventative strategies and 6 on the outcome of POAF. Of these studies only two were original and the remaining were either performed in AF in general population (n=10) or had been studied and reported several times before in cardiac surgery (n=50). The average impact factor of the journals that POAF was published in was only 2.8 ranging between 0.5 and 14.5. Conclusion: Post cardiac surgery atrial fibrillation is a multi-factorial and complex condition. Cardiac surgery may be a risk factor for developing POAF in patients already susceptible to this condition and may not be a complication of cardiac surgery. Future studies should mainly focus on histological changes in the conductive tissue of atrium and related treatment strategies rather than predictive factors of POAF and more funding should be made available to study this condition from new and entirely different perspectives.