What is the clinical evidence from this study?

Study design: Cohort. Population: Paroxysmal atrial fibrillation (n=1069). Intervention: Black race vs. White race. Primary outcome: Log-transformed atrial fibrillation burden (percentage of analyzable time in AF) (adjusted relative estimate -58%, 95% CI -78% to -21%, p=0.02).

What question did this study set out to answer?

This research aims to investigate how race and ethnicity affect the burden of atrial fibrillation (AF) in adults with paroxysmal AF.

June 18, 2026npj Cardiovascular Health0 citationsOpen Access

Race/ethnicity and burden of atrial fibrillation in adults with paroxysmal atrial fibrillation

AGAlan GoCalifornia Institute of Technology KRKristi ReynoldsKaiser Permanente JYJingrong YangHeart Failure & Transplant

Key Result

Compared to White patients, Black patients with paroxysmal atrial fibrillation had a 58% lower adjusted relative burden of atrial fibrillation, while Asian or Pacific Islander patients had a 57% higher burden.

Key Points

This research aims to investigate how race and ethnicity affect the burden of atrial fibrillation (AF) in adults with paroxysmal AF.
Identified 1069 adults with paroxysmal AF using 14-day electrocardiographic monitoring
Collected data on race/ethnicity, demographics, and stroke risk factors from electronic health records
Used multivariable models to evaluate the association of race/ethnicity with log-transformed AF burden.
Median AF burden was 4% with variation by race: White (3.6%), Black (1.4%), Asian/Pacific Islander (5.7%), Hispanic (2.5%)
Black patients had 58% lower AF burden compared to White patients (95% CI: -78% to -21%)
Asian/Pacific Islander patients had 57% higher AF burden compared to White patients (95% CI: 7% to 130%).

Study Design

Type

Cohort (n=1,069)

Multicenter

Yes

Structured PICO

Is race/ethnicity associated with atrial fibrillation burden in adults with paroxysmal atrial fibrillation?

Population

1,069 adults aged 18 years or older with confirmed paroxysmal atrial fibrillation who underwent up to 14 days of continuous ambulatory electrocardiographic monitoring.

Exposure

Race/ethnicity (Black, Asian/Pacific Islander, Hispanic)

Comparator

White race/ethnicity

Outcome

Log-transformed atrial fibrillation burden (percentage of analyzable time in AF during 14-day monitoring)surrogate

In adults with paroxysmal atrial fibrillation, AF burden varies significantly by race/ethnicity, being lower in Black patients and higher in Asian/Pacific Islander patients compared to White patients.

Main Result

Effect estimate: adjusted relative estimate -58% (95% CI -78% to -21%)

Absolute Event Rate: 1.4% vs 3.6%

p-value: p=0.02

Limitations

Clinically-driven testing with potential selection bias
Small size of the Black patient subgroup
Lack of detailed information on subgroups of Asian or Pacific Islanders
Unable to examine explanatory pathways for differential AF burden
Self-reported race and ethnicity are sociocultural constructs
Classification of paroxysmal AF based only on observed burden during monitoring
Unclear clinical implications of the observed magnitude of variation in AF burden
Derived from integrated health care delivery systems in California, potentially limiting generalizability

Abstract

Conflicting data exist about whether race/ethnicity affects risk of atrial fibrillation (AF) but less is known about how race/ethnicity is associated with AF burden in paroxysmal AF. We identified members of Kaiser Permanente Northern and Southern California healthcare systems who underwent 14-day continuous ambulatory electrocardiographic monitoring (ZIO ® XT Patch, iRhythm Technologies, Inc.) between October 2011-October 2016 and had paroxysmal AF during monitoring. Self-reported race/ethnicity, other demographics, and stroke risk factors were obtained from electronic health records. Multivariable models evaluated the association of race/ethnicity with log-transformed AF burden (i.e., percentage of analyzable time in AF). Among 1069 adults with paroxysmal AF confirmed on continuous electrocardiographic monitoring, mean age was 69.1 years, with 45% women, 4% Black, 13% Asian/Pacific Islander, and 11% Hispanic. Median AF burden was 4% (IQR:1–13%) and varied by race/ethnicity: White (3.6%), Black (1.4%), Asian/Pacific Islander (5.7%), Hispanic (2.5%). In multivariable analyses, compared to White patients, Black patients had lower AF burden (adjusted relative estimate: -58%, 95%CI:-78% to -21%), while Asian/Pacific Islander patients had higher AF burden (adjusted relative estimate: 57%, 95%CI:7% to 130%). These findings have implications about the utility of extended continuous electrocardiographic monitoring for better understanding AF and for personalizing management across diverse populations.

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