Association of Race and Ethnicity With Stroke and Mortality Outcomes in Atrial Fibrillation.

Essien UR, Tang JJ, Kim N, Hausmann LRM, Washington DL, Mor MK, Nguyen VP, Magnani JW, Gellad WF, Fine MJ. Association of Race and Ethnicity With Stroke and Mortality Outcomes in Atrial Fibrillation. JACC. Advances. 2025 Jun 5; 4(7):101860, DOI: 10.1016/j.jacadv.2025.101860.

Related HSR&D Project(s)

• CDA 20-049 – Access, Quality and Equity of Anticoagulants in Veterans with Atrial Fibrillation

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Abstract:

BACKGROUND: Atrial fibrillation (AF) is associated with stroke and mortality. Research has demonstrated racial and ethnic disparities in AF outcomes, yet our understanding of the determinants of these disparities is limited. OBJECTIVES: The authors compared stroke and mortality by race and ethnicity for AF patients in the Veterans Health Administration. METHODS: We identified Veterans Health Administration patients with incident AF from January 1, 2014, to December 31, 2021, with follow-up through May 31, 2022. Our independent variables were race (American Indian/Alaska Native (AI/AN), Asian, Black, and White) and ethnicity (Hispanic). Our primary outcomes were stroke and mortality incidence. Cox proportional hazard models assessed the association between race, ethnicity, and our outcomes, adjusting for sociodemographic, clinical, and facility factors. RESULTS: Our cohort included 157,332 patients with AF; mean age 72.9 ± 10.5 years, 97.8% male and 2.2% female. Overall, 22,628 (14.7%) patients developed stroke (46.3 per 1,000 person-years), and 52,288 (33.2%) patients died (96.1 per 1,000 person-years). The adjusted HR (aHR) for stroke was higher for Black (aHR: 1.14; 95% CI: 1.09-1.20) than White patients, with no differences observed between AI/AN, Asian, or Hispanic and White patients. Mortality was lower for Asian (aHR: 0.85; 95% CI: 0.78-0.93), Black (aHR: 0.92; 95% CI: 0.89-0.95), and Hispanic (aHR: 0.82; 95% CI: 0.77-0.87) than White patients, with no difference observed for AI/AN patients. CONCLUSIONS: In a nationwide cohort of AF patients, we found significantly higher stroke rates for Black than White patients. Conversely, we observed significantly lower mortality rates for Asian, Black, and Hispanic patients than for White patients. Interventions to address factors associated with these disparities are essential.