Duke University Medical Center, Durham, North Carolina.
Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
Heart Rhythm. 2018 Sep;15(9):1337-1345. doi: 10.1016/j.hrthm.2018.05.019. Epub 2018 May 24.
Atrial fibrillation (AF) is the most common cardiac arrhythmia in the United States and is associated with increased morbidity, mortality, and health care expenditures. In this review, our aim was to assess the racial and ethnic differences in the epidemiology, management, and outcomes of patients with AF. A search of relevant studies from January 1, 2007, to December 30, 2017, was conducted in PubMed, EMBASE, and Web of Science and supplemented by manual searches of the bibliographies of retrieved articles. We identified 152 studies of which 64 were subsequently included. We found that underrepresented racial and ethnic groups have a higher prevalence of established risk factors associated with the development of AF but an overall lower incidence and prevalence of AF as compared with non-Hispanic whites. Moreover, racial and ethnic differences exist in detection, awareness, and AF-associated symptoms. Nonwhite populations also experience decreased use of rhythm control modalities and anticoagulation for stroke prevention. Lastly, among those with AF, underrepresented racial and ethnic groups had increased morbidity and mortality relative to white groups. Racial and ethnic differences exist in the prevalence, quality of life, management, and outcomes of individuals with AF; however, the mechanisms for these differences have yet to be fully elucidated. Racial and ethnic differences in AF warrant further analysis to understand the factors contributing to the differences in prevalence and management to ensure the delivery of high quality care that prevents stroke, reduces deaths, and decreases expenses associated with caring for underrepresented populations with AF.
心房颤动（AF）是美国最常见的心律失常，与发病率、死亡率和医疗保健支出增加有关。在本次综述中，我们旨在评估 AF 患者在流行病学、管理和结局方面的种族和民族差异。我们在 PubMed、EMBASE 和 Web of Science 中检索了 2007 年 1 月 1 日至 2017 年 12 月 30 日的相关研究，并通过检索文章的参考文献进行了手工检索。我们确定了 152 项研究，其中 64 项随后被纳入。我们发现，代表性不足的种族和民族群体具有更高的与 AF 发展相关的既定风险因素的患病率，但与非西班牙裔白人相比，AF 的总体发病率和患病率较低。此外，在检测、认识和 AF 相关症状方面也存在种族和民族差异。非白人人群也较少使用节律控制方式和抗凝剂来预防中风。最后，在 AF 患者中，代表性不足的种族和民族群体的发病率和死亡率相对白人组更高。AF 患者的患病率、生活质量、管理和结局存在种族和民族差异；然而，这些差异的机制尚未完全阐明。AF 中的种族和民族差异需要进一步分析，以了解导致患病率和管理差异的因素，从而确保提供高质量的护理，预防中风，降低死亡率，并降低为代表性不足的 AF 人群提供护理相关的费用。
