Black Patients Face Greater Risk for Poor Afib Outcomes

JUNE 29, 2016
Meghan Ross, Senior Associate Editor
Black patients with atrial fibrillation are more likely to experience stroke, heart failure, and coronary heart disease than their white counterparts.
New research published in JAMA Cardiology dove into these concerning racial differences.  
“We are careful to distinguish the findings as racial differences rather than disparities, as disparities suggest a systemic etiology for different treatments or therapies,” lead study author Jared W. Magnani, MD, MSc, from Boston University School of Medicine, told Pharmacy Times. “However, racial disparities in atrial fibrillation are also well recognized and are likely multifactorial in origin.”
Racial differences are independent of social factors, while racial disparities come from biases, the researchers explained. 
Compared with white patients, black patients with atrial fibrillation are less likely to receive anticoagulation and advanced antiarrhythmic therapies and procedures, even though they’re more likely to experience adverse outcomes related to atrial fibrillation. 
Because pharmacists are at the front line of patient care, Dr. Magnani believes they can make a difference in improving atrial fibrillation treatment for black patients. 
“Overall, pharmacists can recognize the increased vulnerability of blacks with atrial fibrillation and be mindful toward improving monitoring and treatment for stroke prevention,” he told Pharmacy Times. 
Although previous study results have already demonstrated that racial disparities exist in cardiovascular disease (especially related to stroke), Dr. Magnani said his results add heart failure, coronary disease, and mortality to the list of racial differences in health-related outcomes in atrial fibrillation. 
“The results alert us toward the vulnerability of black Americans with atrial fibrillation,” he said. 
One contributing factor is that atrial fibrillation may not be recognized in as many black patients as white patients, which could be related to health care access or differences in screening, Dr. Magnani said. In addition, black patients aren’t recruited for cardiovascular studies and trials as frequently as white patients, the researchers noted. 
Dr. Magnani and his colleagues used the Atherosclerosis Risk in Communities study as their prospective cohort. This study involved more than 15,700 patients, and the data was collected between 1987 and 1989, with a follow-up period between 2011 and 2013. Race was self-reported as white, black, or other. 
The final study group was 15,080 patients, including 3831 black individuals. The researchers found 2348 cases of atrial fibrillation. 
The rate difference for stroke in individuals with atrial fibrillation was 10.2% in white patients, compared with 21.4% in black patients. In terms of heart failure and coronary heart disease, black patients had a 1.5- to 2-fold higher rate than white patients. 
“The clear consensus is that, in general, black Americans experience far worse health outcomes in the United States than whites,” Dr. Magnani concluded. 
Atrial fibrillation affects around 1% of Americans, and more than 5% are aged 65 years or older. 

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