Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA.
Stanford Center for Clinical Research, Stanford University, Stanford, CA, USA.
J Interv Card Electrophysiol. 2023 Aug;66(5):1279-1290. doi: 10.1007/s10840-022-01383-x. Epub 2022 Oct 13.
Atrial fibrillation (AF) affects around 6 million Americans. AF management involves pharmacologic therapy and/or interventional procedures to control rate and rhythm, as well as anticoagulation for stroke prevention. Different populations may respond differently to distinct management strategies. This review will describe disparities in rate and rhythm control and their impact on outcomes among women and historically underrepresented racial and/or ethnic groups.
This is a narrative review exploring the topic of sex and racial and/or ethnic disparities in rate and rhythm management of AF. We describe basic terminology, summarize AF epidemiology, discuss diversity in clinical research, and review landmark clinical trials.
Despite having higher rates of traditional AF risk factors, Black and Hispanic adults have lower risk of AF than non-Hispanic White (NHW) patients, although those with AF experience more severe symptoms and report lower quality-of-life scores than NHW patients with AF. NHW patients receive antiarrhythmic drugs, cardioversions, and invasive therapies more frequently than Black and Hispanic patients. Women have lower rates of AF than men, but experience more severe symptoms, heart failure, stroke, and death after AF diagnosis. Women and people from diverse racial and ethnic backgrounds are inadequately represented in AF trials; prevalence findings may be a result of underdetection.
Race, ethnicity, and gender are social determinants of health that may impact the prevalence, evolution, and management of AF. This impact reflects differences in biology as well as disparities in treatment and representation in clinical trials.
心房颤动（AF）影响约 600 万美国人。AF 的管理包括药物治疗和/或介入程序以控制心率和节律，以及抗凝以预防中风。不同人群可能对不同的管理策略有不同的反应。本综述将描述女性和历史上代表性不足的种族和/或族裔群体在心率和节律控制方面的差异及其对结局的影响。
这是一篇描述 AF 心率和节律管理中性别和种族/族裔差异的叙述性综述。我们描述了基本术语，总结了 AF 的流行病学，讨论了临床研究中的多样性，并回顾了标志性的临床试验。
尽管黑人及西班牙裔成年人具有更高的传统 AF 危险因素发生率，但与非西班牙裔白人（NHW）患者相比，他们患 AF 的风险较低，尽管与 NHW 患者相比，患有 AF 的黑人和西班牙裔成年人经历更严重的症状并且报告的生活质量评分更低。NHW 患者比黑人和西班牙裔患者更频繁地接受抗心律失常药物、电复律和侵入性治疗。女性患 AF 的比率低于男性，但在 AF 诊断后经历更严重的症状、心力衰竭、中风和死亡。女性和来自不同种族和族裔背景的人在 AF 试验中的代表性不足；患病率的发现可能是由于漏诊。
种族、民族和性别是影响 AF 的流行、演变和管理的健康社会决定因素。这种影响反映了生物学差异以及治疗和临床试验代表性方面的差异。
