Journal article
Effect of Race on Outcomes (Stroke and Death) in Patients >65 Years With Atrial Fibrillation
The American journal of cardiology, Vol.116(2), pp.230-235
07/15/2015
DOI: 10.1016/j.amjcard.2015.04.012
PMCID: PMC4780330
PMID: 26004053
Abstract
Atrial fibrillation (AF) is associated with stroke and death. We sought to determine whether there are any racial differences in the outcomes of death and stroke in patients with AF. We used Medicare administrative data from January 1, 2010, to December 31, 2011, to identify 517,941 patients with newly diagnosed AF. Of these, 452,986 patients (87%) were non-Hispanic white, 36,425 (7%) were black, and 28,530 (6%) were Hispanic. The association between race and outcomes of death and stroke were measured using Cox proportional hazard models. Over a median follow-up period of 20.3 months, blacks had a significantly higher hazard of death (hazard ratio [HR] = 1.46; 95% confidence interval [CI] 1.43 to 1.48; p <0.001) and stroke (HR = 1.66; 95% CI 1.57 to 1.75; p <0.001), compared with white patients. After controlling for pre-existing co-morbidities, the higher hazard of death in blacks was eliminated (HR 0.95; 95% CI 0.93 to 0.96; p <0.001) and the relative hazard of stroke was reduced (HR = 1.46; 95% CI 1.38 to 1.55; p <0.001). Similarly, Hispanics had a higher risk of death (HR = 1.11; 95% CI 1.09 to 1.14; p <0.001) and stroke (HR = 1.21; 95% CI 1.13 to 1.29; p <0.001) compared with whites. The relative hazard of death was lower in Hispanics (HR 0.82; 95% CI 0.80 to 0.84; p <0.001) compared with whites, after controlling for pre-existing co-morbidities, and the relative hazard of stroke was also attenuated (HR = 1.11; 95% CI 1.03 to 1.18; p <0.001). In conclusion, in patients >65 years with newly diagnosed AF, the risks of death and stroke are higher in blacks and Hispanics compared with whites. The increased risk was eliminated or significantly reduced after adjusting for pre-existing co-morbidities. AF may be a marker for underlying co-morbidities in black and Hispanic patients who may be at a higher mortality risk.
Details
- Title: Subtitle
- Effect of Race on Outcomes (Stroke and Death) in Patients >65 Years With Atrial Fibrillation
- Creators
- Rajesh Kabra - Division of Cardiology, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TennesseePeter Cram - Department of Internal Medicine, University of Toronto, Toronto, Ontario, CanadaSaket Girotra - Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IowaMary Vaughan Sarrazin - Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- The American journal of cardiology, Vol.116(2), pp.230-235
- DOI
- 10.1016/j.amjcard.2015.04.012
- PMID
- 26004053
- PMCID
- PMC4780330
- NLM abbreviation
- Am J Cardiol
- ISSN
- 0002-9149
- eISSN
- 1879-1913
- Publisher
- Elsevier Inc
- Grant note
- DOI: 10.13039/100007217, name: Health Services Research and Development; DOI: 10.13039/100000738, name: U.S. Department of Veterans Affairs; DOI: 10.13039/100004374, name: Medtronic; DOI: 10.13039/100000133, name: Agency for Healthcare Research and Quality, award: K18HS021992; DOI: 10.13039/100006279, name: St. Jude Medical
- Language
- English
- Date published
- 07/15/2015
- Academic Unit
- Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984063130402771
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