Chen, Lin

Background: Women and African Americans with atrial fibrillation (AF) experience higher rates of stroke compared to men and white AF patients, respectively. However, sex and race differences for cardiovascular outcomes other than stroke have not been specifically evaluated in patients with AF. Methods: We studied patients with AF in the Optum Clinformatics database between 2009 and 2015 with at least 6 months of enrollment before AF diagnosis. The Optum Clinformatics database includes medical and pharmacy claims and sociodemographic information on privately insured and Medicare Advantage enrollees throughout the US. Endpoints (hospitalizations for ischemic stroke, heart failure (HF), myocardial infarction (MI)) and covariates were defined using validated algorithms. Multivariable Cox models were used to study the association of race and sex with endpoints of interest. Results: The analysis included 380,636 eligible participants (mean age 73, women 45%). Of them, 82% were white, 9% African American, 7% Hispanic and 2% Asian American. During a mean follow-up of 23 months, 7,235 suffered ischemic stroke, 17,258 HF, and 5,585 MI. Crude rates of ischemic stroke and HF were higher in women than men, while men had higher rates of MI than women (Table). African Americans and Hispanics had higher rates of all studied outcomes than whites and Asian Americans. In models including age, sex, race, education and CHA 2 DS 2 -VASc score, women had higher risk of ischemic stroke and lower risk of HF and MI compared to men. Compared to whites, African Americans had 1.4 times the rate of HF and stroke, and 1.1 times the rate of MI, while Asian Americans had 16% lower rates of HF. No major differences were observed between rates in whites and Hispanics (Table). Conclusion: In a large insured population of patients with AF, we observed differences in rates of selected cardiovascular outcomes by sex and race. Additional research should explore the mechanisms underlying these differences and develop strategies to eliminate them.

Background: Multimorbidity is common in atrial fibrillation (AF); however, the impact of the number and type of comorbid conditions on death and hospitalizations is uncertain. Methods: The prevalence of 17 chronic conditions was obtained in 1430 patients with incident AF from 2000-2010 from Olmsted County, MN. Chronic conditions were ascertained electronically prior to AF and were classified into 3 groups: cardiovascular (CV), other physical, and mental. All hospitalizations and deaths were obtained through 12/31/2014. Associations of the number and type of condition and each individual condition with hospitalizations and death were determined using Andersen-Gill and Cox regression, respectively. Results: Among the 1430 patients with AF (median age 76 years, 48.6% men), the mean (SD) number of chronic conditions was 4.7 (2.7). A total of 4496 hospitalizations and 812 deaths occurred over a mean (SD) follow-up of 5.4 (4.1) years. An increase in the number of conditions of each type was associated with increased risks of death and hospitalizations (Table). Mental conditions (which included depression, anxiety, dementia, schizophrenia, and substance abuse) exhibited the strongest association with death, whereas other physical conditions exhibited the strongest association with hospitalizations. Individual predictors of death included heart failure (HF), hypertension, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), depression, dementia, and substance abuse. Predictors of hospitalizations included HF, coronary artery disease, diabetes, COPD, CKD, arthritis, osteoporosis, and substance abuse. Conclusions: Patients with AF have many comorbid conditions which are associated with death and hospitalizations. Although conditions of each type were associated with outcomes, mental conditions exhibited strongest association with death. These data highlight the importance of management of not only CV comorbidities but other physical and mental comorbidities in patients with AF.