Background

An early rhythm control strategy is the preferred management for patients newly diagnosed with atrial fibrillation (AF). A rhythm control strategy, however, has been historically underutilized for patients from underrepresented racial and ethnic groups (UREGs).

Objective

We aimed to determine whether disparities in rhythm control are present at the initial diagnosis with AF.

Methods

We used the GWTG-Atrial Fibrillation registry to compare the use of a rhythm control strategy among patients with different racial and ethnic backgrounds hospitalized with a new diagnosis of AF from 1/2013-12/2023.

Results

Among 21,567 patients hospitalized for newly detected AF across 249 hospitals, 17,659 patients (81.9%) identified as non-Hispanic White (NHW), 1,860 patients (8.6%) identified as Black, 1,232 patients (5.7%) identified as Hispanic, and 255 patients (1.2%) identified as Asian. After adjusting for age, sex and year of presentation, NHW patients were more likely to receive rhythm control (OR 1.19 [1.07, 1.33], p = 0.0013) compared to non-White patients at the time of initial diagnosis with AF. Black patients were less likely to receive rhythm control compared to all other racial and ethnic groups (OR 0.80 [0.71, 0.91], p=0.0005). These differences persisted after fully adjusting for demographic characteristics, clinical variables, hospital characteristics and socioeconomic factors.

Conclusions

Differences in rhythm management exist amongst patients from different racial and ethnic groups. Efforts to mitigate disparities in AF management should include an emphasis on rhythm control at the time of initial diagnosis.