Introduction: Racial disparities in cardiovascular therapies and outcomes have been previously reported. We sought to investigate the risks of stroke and death in African American (AA) and white patients undergoing rhythm control of atrial fibrillation (AF).
Hypothesis: AA patients have greater risk of stroke and death compared to white patients.
Methods: We collected data on 5632 white and 241 AA patients that initiated rhythm control therapy for AF at our institution from 2006-2013. Cox proportional-hazards models were used to assess risk factors for stroke and mortality by race.
Results: Patients were followed for a median of 40 months (range 1-101). AA patients had higher risk of stroke (6.6% vs. 3.9%, p=0.01) and all-cause mortality (16.2% vs. 13.1%, p=0.03) than white patients. Multivariate modeling confirmed the higher risk of stroke (HR=1.98, 95% CI [1.18-3.31], p=0.01) and mortality (HR=1.49, 95% CI [1.04-2.06], p=0.02) in AA patients after adjusting for baseline differences between race groups (age, HTN, DM, heart failure, and chronic kidney disease). AA patients with DM had an especially high risk of stroke (see Figure).
Conclusions: African-American patients treated with a rhythm management strategy had significantly greater risk of stroke and all-cause mortality compared to white patients. AA patients with DM had an especially high risk, but the difference between AA patients vs. white patients was not explained by differences in baseline risk factors. Further investigation is required to determine the root causes of these racial disparities.