Racial and ethnic disparities in the management of risk factors in individuals with atrial fibrillation: A narrative review

Atrial fibrillation (AF) is the most prevalent arrhythmia, affecting approximately 10 million individuals in the United States and nearly 60 million people globally. Significant racial and ethnic disparities exist in rates of complications for individuals with AF. Compared to White patients, Black and Hispanic patients are significantly more likely to experience stroke and death. While research has examined pharmacoequity in receipt of stroke-preventing therapies among individuals with AF, limited literature exists examining disparities in risk factor management for AF complications. The American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines have identified ten risk factors whose effective management reduces the recurrence of AF, symptom burden, and complications. Six cardiometabolic risk factors, selected given the availability of evidence-based therapies to manage them, will be discussed herein including obesity, hypertension, diabetes, obstructive sleep apnea, alcohol consumption, and tobacco use. We seek to highlight the data examining how risk factors contribute to poor outcomes in patients with AF and to summarize the data on racial and ethnic disparities in the management of those risk factors in this patient population. Lastly, we provide a call to action to achieve pharmacoequity in AF risk factor management and improve downstream outcomes.