Racial Differences in the Prevalence and Outcomes of Atrial Fibrillation Among Patients Hospitalized With Heart Failure

Abstract

Background The intersection of heart failure ( HF ) and atrial fibrillation ( AF ) is common, but the burden of AF among black patients with HF is poorly characterized. We sought to determine the prevalence of AF , characteristics, in‐hospital outcomes, and warfarin use associated with AF in patients hospitalized with HF as a function of race. Methods and Results We analyzed data on 135 494 hospitalizations from January 2006 through January 2012 at 276 hospitals participating in the A merican H eart A ssociation's G et W ith T he G uidelines HF Program. Multivariable logistic regression models using generalized estimating equations approach for risk‐adjusted comparison of AF prevalence, in‐hospital outcomes, and warfarin use. In this HF population, 53 389 (39.4%) had AF . Black patients had markedly less AF than white patients (20.8% versus 44.8%, P <0.001). Adjusting for risk factors and hospital characteristics, black race was associated with significantly lower odds of AF ( adjusted odds ratio 0.52, 95% CI 0.48 to 0.55, P <0.0001). There were no racial differences in in‐hospital mortality; however, black patients had a longer length of stay relative to white patients. Black patients compared with white patients with AF were less likely to be discharged on warfarin ( adjusted odds ratio 0.76, 95% CI 0.69 to 0.85, P <0.001). Conclusions Despite having many risk factors for AF , black patients, relative to white patients hospitalized for HF , had a lower prevalence of AF and lower prescription of guideline‐recommended warfarin therapy.