What does this research mean for the field?

The lower reported prevalence of atrial fibrillation among African-Americans and residents of the US Stroke Belt is partially an artifact of diagnostic test sensitivity, with the inverse association between these groups and AF attenuating as detection methods become more sensitive. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine whether the sensitivity of methods used to detect atrial fibrillation explains paradoxical ethnic and regional variations in prevalence.

January 1, 2009Journal of EpidemiologyOpen Access

The Sensitivity of the Method Used to Detect Atrial Fibrillation in Population Studies Affects Group-Specific Prevalence Estimates: Ethnic and Regional Distribution of Atrial Fibrillation in the REGARDS Study

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Why the study?

Does the sensitivity of the method used to detect atrial fibrillation affect group-specific prevalence estimates among different ethnic groups and geographic regions?

Population

18,833 black and white adults aged at least 45 years from the US national REasons For Geographic And Racial…

Design

Cross-sectional, ECGs were read and coded by electrocardiographers blinded to…

Authors

RPRonald J. PrineasPreventive Cardiology ESElsayed Z. SolimanCornell University GHGeorge HowardBrigham Young University

Discussion

Member takes

Overview

AF detection sensitivity may bias ethnic prevalence estimates downward; leaves open whether true differences persist with sensitive methods.

Key Points

To determine whether the sensitivity of methods used to detect atrial fibrillation explains paradoxical ethnic and regional variations in prevalence.
Analyzed cross-sectional data from 18,833 Black and White participants enrolled in the US national REGARDS study.
Defined four diagnostic sensitivity tiers using combinations of self-report and 12-lead electrocardiography (ECG): self-report plus ECG, ECG alone, self-report alone, and self-report or ECG.
Calculated multivariable-adjusted odds ratios for atrial fibrillation according to Stroke Belt residence and Black ethnicity across each diagnostic sensitivity level.
Stroke Belt residence was negatively associated with atrial fibrillation when diagnosed by self-report plus ECG (multivariable-adjusted OR, 0.66; 95% CI, 0.47 to 0.92), but showed no significant association when diagnosed by the most sensitive method of self-report or ECG (OR, 0.95; 95% CI, 0.85 to 1.06).
The inverse association between Black ethnicity and atrial fibrillation progressively weakened as detection sensitivity increased across the four diagnostic tiers (ORs: 0.20, 0.40, 0.70, and 0.71, respectively).

Structured PICO

Does the sensitivity of the method used to detect atrial fibrillation affect group-specific prevalence estimates among different ethnic groups and geographic regions?

Population

18,833 black and white adults aged at least 45 years from the US national REasons For Geographic And Racial Differences In Stroke (REGARDS) study, mean age 65.9 years, 51.5% female, 41% black.

Outcome

Odds ratios of atrial fibrillation associated with the Stroke Belt and black ethnicity for each diagnostic combination (self-report plus ECG, ECG alone, self-report alone, and self-report or ECG)

The association of atrial fibrillation with black ethnicity and residence in the Stroke Belt is inversely related to the sensitivity of the detection method, suggesting that lower reported AF prevalence in these high-stroke-risk groups may be an artifact of insensitive diagnostic methods.

Limitations

Selection bias due to exclusion of participants with a history of stroke
Potential differences in participants' understanding of the term 'atrial fibrillation'
Inequities in access to proper healthcare might have resulted in less self-reported AF among blacks
Lack of long-term Holter monitoring data to determine true prevalence

Cite This Study

Prineas et al. (2009) studied this question.

synapsesocial.com/papers/6a1968fbf2eb401dc7890cf5 https://doi.org/10.2188/jea.je20081032

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January 1, 2009Journal of EpidemiologyOpen Access

The Sensitivity of the Method Used to Detect Atrial Fibrillation in Population Studies Affects Group-Specific Prevalence Estimates: Ethnic and Regional Distribution of Atrial Fibrillation in the REGARDS Study

View Full Paper

Ask AI

Bookmark

Why the study?

Does the sensitivity of the method used to detect atrial fibrillation affect group-specific prevalence estimates among different ethnic groups and geographic regions?

Population

18,833 black and white adults aged at least 45 years from the US national REasons For Geographic And Racial…

Design

Cross-sectional, ECGs were read and coded by electrocardiographers blinded to…

Authors

RPRonald J. PrineasPreventive Cardiology ESElsayed Z. SolimanCornell University GHGeorge HowardBrigham Young University

Discussion

Member takes

Overview

AF detection sensitivity may bias ethnic prevalence estimates downward; leaves open whether true differences persist with sensitive methods.

Key Points

To determine whether the sensitivity of methods used to detect atrial fibrillation explains paradoxical ethnic and regional variations in prevalence.
Analyzed cross-sectional data from 18,833 Black and White participants enrolled in the US national REGARDS study.
Defined four diagnostic sensitivity tiers using combinations of self-report and 12-lead electrocardiography (ECG): self-report plus ECG, ECG alone, self-report alone, and self-report or ECG.
Calculated multivariable-adjusted odds ratios for atrial fibrillation according to Stroke Belt residence and Black ethnicity across each diagnostic sensitivity level.
Stroke Belt residence was negatively associated with atrial fibrillation when diagnosed by self-report plus ECG (multivariable-adjusted OR, 0.66; 95% CI, 0.47 to 0.92), but showed no significant association when diagnosed by the most sensitive method of self-report or ECG (OR, 0.95; 95% CI, 0.85 to 1.06).
The inverse association between Black ethnicity and atrial fibrillation progressively weakened as detection sensitivity increased across the four diagnostic tiers (ORs: 0.20, 0.40, 0.70, and 0.71, respectively).

Structured PICO

Does the sensitivity of the method used to detect atrial fibrillation affect group-specific prevalence estimates among different ethnic groups and geographic regions?

Population

18,833 black and white adults aged at least 45 years from the US national REasons For Geographic And Racial Differences In Stroke (REGARDS) study, mean age 65.9 years, 51.5% female, 41% black.

Outcome

Odds ratios of atrial fibrillation associated with the Stroke Belt and black ethnicity for each diagnostic combination (self-report plus ECG, ECG alone, self-report alone, and self-report or ECG)

Limitations

Selection bias due to exclusion of participants with a history of stroke
Potential differences in participants' understanding of the term 'atrial fibrillation'
Inequities in access to proper healthcare might have resulted in less self-reported AF among blacks
Lack of long-term Holter monitoring data to determine true prevalence

Cite This Study

Prineas et al. (2009) studied this question.

synapsesocial.com/papers/6a1968fbf2eb401dc7890cf5 https://doi.org/10.2188/jea.je20081032

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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