Abstract 4367607: Disparities in Atrial Fibrillation Clinical Outcomes: Race, Ethnicity, and Sex Differences in Risk of Incident Heart Failure, Stroke, and Mortality

Introduction: Atrial fibrillation (AF) is associated with significant comorbidities, including stroke and tachyarrhythmia-associated heart failure (HF). The role of patient characteristics such as race, ethnicity and sex have been implicated in AF, especially in the risk of cardioembolic stroke, however the risk of incident AF-associated HF and clinical outcomes are less established. Research Questions: This study aims to characterize clinical outcomes in new onset AF and AF mediated cardiomyopathy across race, ethnicity and sex. Methods: We conducted a retrospective propensity-score matched cohort study of adult patients between January 2010 and November 2024 at a single center who didn’t have a prior history of AF or HF by diagnostic code or EF < 50% or embolic stroke. Those who developed a new diagnosis of AF were included. A HF diagnosis was defined as a new diagnosis of HFrEF by diagnostic code or a measured EF < 40%. The primary exposure variables of interest were race, ethnicity and sex. We assessed outcomes among both patients with and without development of HF within 1 year of AF onset. The primary outcome included mortality, incidence of HF, stroke, and HF hospitalization. Data analysis was conducted by Atropos Health. Results: A total of 12,907 patients met inclusion criteria and 4,052 of those patients developed HF within 1 year of AF diagnosis. Among all patients with new-onset AF, males had increased risk of mortality (HR 1.18, 95% CI 1.04-1.33, p = 0.008), development of HF (HR 1.16, 95% CI 1.08-1.24, p < 0.001) and HF hospitalization (HR 1.15, 95% CI 1.04-1.27, p = 0.005) compared to females. Native Hawaiian/Pacific Islander patients exhibited elevated HF incidence (HR 2.41, 95% CI 1.55-3.74, p < 0.001) and hospitalization rates (HR 2.03, 95% CI 1.36-3.03, p < 0.001), while Asian patients had increased stroke risk (HR 1.35, 95% 1.07-1.7, p = 0.01) but lower HF and hospitalization rates compared to whites. African American and American Indian patients showed no significant outcome differences. In the HF subgroup, Asian patients retained heightened stroke risk (HR 1.7, 95% CI 1.27-3, p = 0.002) compared to white patients. Conclusion: Our study shows that significant disparities in AF clinical outcomes with or without incident HF exist across race, ethnicity, and sex. These findings underscore the need for tailored management strategies to address sociodemographic inequities and improve cardiovascular outcomes in diverse populations.