Impact of Race and Ethnicity on the Rhythm Control of Newly Diagnosed Atrial Fibrillation: Insights from the Get With the Guidelines Atrial Fibrillation Registry

Connor P Oates; Larry R Jackson 2nd; Rebecca Young; Karen Chiswell; Anne B Curtis; Jonathan P Piccini; Vivek Y Reddy; William Whang

doi:10.1016/j.hrthm.2024.11.003

Impact of Race and Ethnicity on the Rhythm Control of Newly Diagnosed Atrial Fibrillation: Insights from the Get With the Guidelines Atrial Fibrillation Registry

Heart Rhythm. 2024 Nov 6:S1547-5271(24)03544-6. doi: 10.1016/j.hrthm.2024.11.003. Online ahead of print.

Authors

Connor P Oates¹, Larry R Jackson 2nd², Rebecca Young², Karen Chiswell², Anne B Curtis³, Jonathan P Piccini², Vivek Y Reddy⁴, William Whang⁴

Affiliations

¹ Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: connor.oates@mountsinai.org.
² Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
³ Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
⁴ Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.

PMID: 39515503
DOI: 10.1016/j.hrthm.2024.11.003

Abstract

Background: An early rhythm control strategy is the preferred management for patients newly diagnosed with atrial fibrillation (AF). A rhythm control strategy, however, has been historically underutilized for patients from underrepresented racial and ethnic groups (UREGs).

Objective: We aimed to determine whether disparities in rhythm control are present at the initial diagnosis with AF.

Methods: We used the GWTG-Atrial Fibrillation registry to compare the use of a rhythm control strategy among patients with different racial and ethnic backgrounds hospitalized with a new diagnosis of AF from 1/2013-12/2023.

Results: Among 21,567 patients hospitalized for newly detected AF across 249 hospitals, 17,659 patients (81.9%) identified as non-Hispanic White (NHW), 1,860 patients (8.6%) identified as Black, 1,232 patients (5.7%) identified as Hispanic, and 255 patients (1.2%) identified as Asian. After adjusting for age, sex and year of presentation, NHW patients were more likely to receive rhythm control (OR 1.19 [1.07, 1.33], p = 0.0013) compared to non-White patients at the time of initial diagnosis with AF. Black patients were less likely to receive rhythm control compared to all other racial and ethnic groups (OR 0.80 [0.71, 0.91], p=0.0005). These differences persisted after fully adjusting for demographic characteristics, clinical variables, hospital characteristics and socioeconomic factors.

Conclusions: Differences in rhythm management exist amongst patients from different racial and ethnic groups. Efforts to mitigate disparities in AF management should include an emphasis on rhythm control at the time of initial diagnosis.

Keywords: Atrial fibrillation; Get With the Guidelines; healthcare delivery; healthcare disparities; rhythm control.