This editorial highlights a retrospective study demonstrating that sex and ethnicity modify 1-year mortality among newly diagnosed atrial fibrillation patients in multiethnic Singapore.
This editorial highlights ethnic differences in the incidence and mortality of atrial fibrillation in Singapore, emphasizing the need for individualized management.
Atrial fibrillation (AF) remains the most common arrhythmia since William Harvey's observation of fibrillating auricles in open chest animal models in 1628.Willem Einthoven first documented ECG tracing of AF in 1906.Fast forward several hundred years since its first observation, AF remains a mystery from its pathogenesis and sustenance to treatment options in the 21st century.AF is known to confer incremental risk of mortality in population-based studies and poses a substantial morbidity burden in terms of stroke and heart failure. 1 Yet, a one-size approach does not fit all in AF treatment and individualised management with shared decisionmaking is encouraged in most clinical guidelines. 2 In fact, even the incidence and prevalence of the same arrhythmia differ between populations and communities.These observations further intrigue and complicate how genetics and environments, together with known risk factors and modifiers, intertwine to give rise to, perpetuate and sustain AF.Recent publications have shown racial and sex differences in mortality for AF in different ethnic groups. 3However, most studies were limited in the West, mainly comparing white versus non-white populations.Regionally, there are interesting differences observed in the prevalence, clinical correlates and outcomes of AF in heart failure patients across Asia. 4 A previous community-based study in Singapore showed a relatively low AF prevalence rate in the Chinese community over the age of 55 years old. 5In this issue of the Annals, Tan et al. had taken further steps to illustrate the interesting differences in the mortality and incidences in multiethnic Singapore. 6Albeit the study was retrospective in nature with its limitations and potential unknown confounding variables, the authors ought to be commended on several pertinent observations.Firstly, the study was consistent with the huge prospective observational study, Global Anticoagulant Registry in the Field (GARFIELD-AF) 7 and demonstrated incremental mortality among newly diagnosed AF patients belonging to the 3 main ethnic groups (Chinese, Malays and Indians) in Singapore.
David Foo (Mon,) conducted a editorial in Atrial fibrillation. This editorial highlights a retrospective study demonstrating that sex and ethnicity modify 1-year mortality among newly diagnosed atrial fibrillation patients in multiethnic Singapore.