Influence of Race on Atrial Fibrillation After Cardiac Surgery

Study Questions:

Is atrial fibrillation (AF) after cardiac surgery less common in black patients than white patients?

Methods:

This was a retrospective analysis of 20,282 white and 1,323 black patients who underwent cardiac surgery. Data were extracted from a prospective cardiovascular database. Postoperative AF was defined as an episode of AF or atrial flutter requiring treatment after cardiac surgery and before discharge from the hospital.

Results:

Postoperative AF occurred significantly more often in white patients (35%) than in black patients (22%). After adjustment for potential confounding variables, the odds of postoperative AF were 74% higher in white patients than black patients. The risk of other postoperative complications such as ventricular tachycardia, renal failure, stroke, and death was similar between white and black patients. The strongest predictors of postoperative AF in blacks were older age (odds ratio 2.1) and need for more perioperative blood transfusions (odds ratio 1.2).

Conclusions:

The authors concluded that risk of AF after cardiac surgery is lower in black patients than in white patients, even after adjustment for multiple confounders such as obesity, hypertension, and diabetes.

Perspective:

Other studies have demonstrated that the incidence of AF also is lower in blacks than whites in outpatient populations. This finding seems paradoxical because comorbidities that increase the risk of AF are more common in blacks than whites. It seems likely that there are racially-determined genetic factors that account for the lower risk of AF in black patients.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Hypertension

Keywords: Incidence, Postoperative Complications, Stroke, Confounding Factors (Epidemiology), Tachycardia, Ventricular, Atrial Fibrillation, Obesity, Cardiac Surgical Procedures, Hypertension, Diabetes Mellitus


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