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Racial Differences in Device-Detected Incident AF
Quick Takes
- Using implantable devices, for continuous AF detection, similar rates of AF were observed among Black and White patients after adjustment for age, sex, and comorbidities.
- Within the subcohort of patients with pacemakers, White individuals had a higher rate of incident AF, while in the subcohort of patients with defibrillators, Black individuals had a higher rate of incident AF.
Study Questions:
How does the risk for atrial fibrillation (AF) compare between Black and White individuals when cardiac implantable electronic devices (CIEDs) are used to detect AF?
Methods:
The investigators used a retrospective observational study design to examine patients who had a CIED implanted between January 1, 2007, and June 1, 2019. Patients with insertable cardiac monitors, insufficient monitoring, or prior AF were excluded. The primary endpoint was the overall adjusted incidence of device-detected AF, defined as ≥6 minutes of AF, between Black and White individuals.
Results:
A total of 441,047 patients had a CIED implanted during the study time period. After exclusions for insertable cardiac monitor, age <18 years, insufficient remote monitoring, and prior history of AF, a total of 88,427 patients were included in the current analysis (mean age, 69 ± 13 years, 8,045 Black [9.1%], and 55,840 males [63.1%]). There were 51,378 patients (58.1%) with implantable cardioverter-defibrillators (ICDs), 24,656 (48.0%) of which were CRT devices. At baseline, Black individuals were younger, more likely to be female, and have shorter follow-up compared to White individuals. Black individuals had a higher prevalence of hypertension, diabetes, heart failure, cerebrovascular disease, and obstructive sleep apnea, while coronary artery disease and peripheral vascular disease were more prevalent in White individuals. The mean follow-up duration was 2.2 ± 1.7 years, during which 35,143 patients (40%) had device-detected AF.
The crude incidence of AF was greater among White, compared with Black, individuals (27.95 vs. 24.86 cases per 100 person-years, p < 0.001). After adjusting for age, sex, and medical comorbidities, the hazard of AF was similar between Black and White individuals (HR, 1.02; 95% CI, 0.98-1.06). In subgroup analysis by type of CIED, White individuals had a greater hazard of AF in the pacemaker cohort, whereas Black individuals had a greater hazard of AF in the ICD cohort. Secondary analyses demonstrate that, in patients >72 years old and those with pacemakers, White individuals demonstrated a higher incidence of AF. However, in patients <62 years old and those with ICDs, Black individuals had a greater incidence of AF.
Conclusions:
The authors conclude that the adjusted risk of AF is similar between Black and White patients with CIEDs.
Perspective:
Implantable devices can monitor for AF on a continuous basis, thus allowing a more detailed examination of AF prevalence among Black and White patients. These data suggest that although risk factors vary by race, after adjustment for age, sex, and comorbidities, the rates of AF were similar between Blacks and Whites. Given the differences in follow-up between Blacks and Whites, longer-term monitoring may be of clinical relevance to confirm these results.
Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Atrial Fibrillation, Defibrillators, Implantable, Race Factors, Wearable Electronic Devices
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