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Mitrani LR, Tumasian RA, Vilches S, De Los Santos J, Gonzalez-Lopez E, Caponetti AG, Saturi G, Mirelis JG, Longhi S, Gagliardi C, Goldsmith J, Rapezzi C, García-Pavía P, Maurer MS. Racial Differences in Atrial Fibrillation Management Between White Patients and Black Patients in Transthyretin Cardiac Amyloid. Am J Cardiol 2023; 187:164-170. [PMID: 36459741 DOI: 10.1016/j.amjcard.2022.10.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/04/2022] [Accepted: 10/17/2022] [Indexed: 11/30/2022]
Abstract
Black patients have higher rates of stroke than White patients. Paradoxically, atrial fibrillation (AF) affects twice as many White patients compared with Black patients. Transthyretin cardiac amyloidosis (ATTR-CA) is associated with both AF and strokes. We hypothesized that although Black patients with ATTR-CA have a lower incidence of AF, when diagnosed with AF, they have increased thromboembolic events. Patients with ATTR-CA (n = 558) at 3 international centers were retrospectively identified. We compared baseline characteristics, presence of AF, outcomes of thromboembolism (stroke, transient ischemic attack, and peripheral embolism), major bleed, and mortality by race. Of all patients, 367 of 488 White patients (75%) were diagnosed with AF compared with 39 of 70 Black patients (56%) (p = 0.001). Black patients with AF had a hazard ratio of 5.78 (95% confidence interval 2.30 to 14.50) for time to first thromboembolic event compared with White patients. There were no racial differences in major bleeding. Black patients with AF more often lacked anticoagulation (p = 0.038) and had higher incidence of labile international normalized ratio (p <0.001). In conclusion, these data suggest that although Black patients with ATTR-CA have lower incidence of AF, they have increased thromboembolic events compared with White patients. These findings may be related to treatment discrepancies, time in therapeutic range for warfarin, and disparities in healthcare.
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Affiliation(s)
| | | | - Silvia Vilches
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain
| | | | - Esther Gonzalez-Lopez
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain
| | | | - Giulia Saturi
- Policlinico di S. Orsola, University of Bologna, Bologna, Italy
| | - Jesus G Mirelis
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain
| | - Simone Longhi
- Policlinico di S. Orsola, University of Bologna, Bologna, Italy
| | | | | | - Claudio Rapezzi
- Policlinico di S. Orsola, University of Bologna, Bologna, Italy
| | - Pablo García-Pavía
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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Vergaro G, Aimo A, Castiglione V, Emdin M. Stroke in ATTR cardiac amyloidosis: Does only rhythm matter? Int J Cardiol 2022; 363:127-128. [PMID: 35716938 DOI: 10.1016/j.ijcard.2022.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant(')Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | - Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant(')Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Vincenzo Castiglione
- Institute of Life Sciences, Scuola Superiore Sant(')Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant(')Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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