Background: A lower prevalence of atrial fibrillation (AF), but paradoxically higher burden of cardiovascular disease risk factors, has been observed among African Americans compared to Whites in studies of AF identified by mostly 12-lead electrocardiograms (ECGs) and clinically. Methods: We performed 48-hour ambulatory electrocardiography (aECG) in a biracial sample of 1,193 participants in the Atherosclerosis Risk in Communities (ARIC) (mean age = 78 years, 62% African Americans, 64% female). Atrial fibrillation was identified from aECG, study visit ECGs, and discharge codes from cohort hospitalizations. We used covariate-adjusted logistic regression to estimate prevalence odds ratios (ORs) for AF in African Americans versus Whites, with adjustment for sampling and nonresponse. Results: African Americans were more likely than Whites to have hypertension and diabetes but less likely to have coronary heart disease. The prevalence of AF detected by aECG or ARIC study ECG (adjusted for age and coronary heart disease) was lower in African Americans than Whites (2.7% vs 5.0%). White men had a higher (although not significant) AF prevalence of 7.8% compared to the other race and gender groups at 2.3%-2.8%. The adjusted OR for AF was 0.49 (0.24-0.99) comparing African Americans to Whites. Findings were similar when AF was defined to include prior AF hospitalizations (OR = 0.42, 0.25-0.72). There were no significant differences by race for asymptomatic or paroxysmal AF. Conclusions: Atrial fibrillation was less prevalent in African American than white older adults, regardless of detection method. Although overall detection of new AF cases with aECG was low, future studies should consider longer-term monitoring to characterize AF by race.
Bibliographical noteFunding Information:
The data that support the findings of this study are available from the corresponding author or the ARIC study upon reasonable request. Research reported here was supported by the NHLBI of the National Institutes of Health (Loehr). The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the NHLBI , National Institutes of Health, Department of Health and Human Services, under contract. Additional support was provided by American Heart Association (Alonso) and NHLBI grants (Chen). Molly Wen assisted with the programming for the analysis for this manuscript.
Research reported here was supported by the NHLBI of the National Institutes of Health under award number R01HL116900 . The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the NHLBI , National Institutes of Health, Department of Health and Human Services, under contract nos. HHSN268201700001I , HHSN268201700002I , HHSN268201700003I , HHSN268201700004I , and HHSN268201700005I . Additional support was provided by American Heart Association grant 16EIA26410001 (Alonso) and by NHLBI grants R01HL126637 and R01HL141288 (Chen). The authors thank the staff and participants of the ARIC study for their important contributions.
© 2019 Elsevier Inc.