The right AFib treatment can head off complications like stroke and heart attack. But many people who have AFib aren’t diagnosed until there’s a serious problem. And others aren't using the most effective treatment strategies.
That’s often because of health disparities, or differences in the ways some groups of people are diagnosed and cared for. With AFib, disparities come from a complicated mix of race, ethnicity, gender, and age biases. Social and economic factors also play big roles. But these differences can – and should – be prevented.
What Are Some Disparities in AFib Diagnosis?
AFib is diagnosed more in white people than in other racial and ethnic groups that generally have more risk factors. Black people are less likely than white people to even know they have AFib.
Access to preventive health care matters. Because AFib symptoms aren’t always obvious, your first clue may not come until the doctor uses a stethoscope to listen to your heart. Without that checkup, you might not get a diagnosis until you have serious symptoms or complications.
Compared with white people and Hispanic people, Black people with AFib report more severe and disabling symptoms.
There are gender-related differences in AFib as well.
Women develop it 10 years later than men, on average. Women also may experience more severe symptoms and a lower quality of life, and they’re more likely than men to have disabling strokes. If you’re a woman, it might take longer to get an AFib diagnosis. You might not think your symptoms are heart-related, or they could be vague, like fatigue or trouble sleeping. Or maybe your doctor dismissed them at first. Women also tend to be undertreated even after diagnosis.
These disparities highlight the need for more research and education.
What Are Some Disparities in AFib Treatment?
People who aren’t white and those with low education levels may be less likely to see a heart specialist for their AFib. And even when they do, white men often still get the best care for it, studies show.
A large cohort study looked at rhythm control strategy, including antiarrhythmic drugs and catheter ablation, in AFib patients. All had commercial health insurance. The researchers found that less rhythm control strategy was associated with:
- Black race
- Lower median household income zip codes
Less use of catheter ablation was associated with:
- Latino ethnicity
- Lower median household income zip codes
According to another study, you’re more likely to have AFib ablation if you have private health insurance. You’re less likely to have ablation if you have Medicare, Medicaid, or no health insurance.
Women may also be less likely to have a catheter ablation for irregular heart rhythms.
A large U.S. Department of Veterans Affairs study found that Black and Asian people with AFib were less likely than white people to be on blood thinners. Among those who did take blood thinners, those less likely to be on the newer ones were:
- Black
- Hispanic
- American Indian/Alaska native
The researchers adjusted for clinical, sociodemographic, doctor, and facility factors. This suggests that these disparities have to do with race and ethnicity.
There are also disparities involving the Watchman device. This heart implant is an alternative to blood thinners and helps prevent AFib-related stroke. In a sample of 34,960 people with AFib who received Watchman implants from 2015 to 2018:
- 86% were white
- 5.9% were Hispanic
- 4.2% were Black
- 3.7% were of other races
Those who were Black, Hispanic, and other races had more complications and stayed in the hospital longer than white people who got the implant.
When compared with white people, Black and Hispanic people with the Watchman device have more comorbidities such as:
- Heart failure
- High blood pressure
- Obesity
- Kidney failure
Compared with White people, Black and Hispanic people and those of other races are more likely to have:
- Major complications
- Longer hospital stays
One glaring problem in AFib treatment is that clinical trials typically lack diversity. One study found that Black people made up only 2% and Hispanic people only 5.6% of AFib trial participants. Other data shows that in AFib ablation clinical trials, only one-fifth of those taking part are women.
How Do Disparities Affect AFib Outcomes?
AFib death rates are rising. They’re higher in older people than younger ones, but they’re increasing faster in adults aged 35 to 64 than in those aged 65 to 84. This trend suggests a lack of early diagnosis and management of AFib.
The age-adjusted mortality rate is highest in white men, followed by Black men, white women, and Black women. However, it’s increasing at a faster pace in Black men.
AFib disparities, and health care disparities in general, are not unique to the United States. In fact, it’s a global problem.
For example, researchers in the U.K. looked at long-term health records of 5.6 million people. They found that when they’re diagnosed with AFib, people who lived in more economically deprived areas had more comorbidities, even though they were younger than those from wealthier areas.
This group had a 12% higher risk of developing AFib, as well as a 26% higher death rate than those who lived in the wealthiest areas.
How Do Social Factors Create Health Disparities in AFib?
Gender, age, and racial and ethnic differences all appear to play roles in the diagnosis and management of AFib. There’s a need for more research into the differences in AFib risk factors and symptoms in these groups.
In addition, a complex mix of social factors, also called social determinants of health, can lead to health care disparities and affect your well-being. These include your:
- Type – or lack – of health insurance
- Overall financial resources
- Access to routine preventive care and ongoing treatment, including distance to doctors and medical facilities
- How much you trust health care providers and follow their advice
- Family and social support systems
- Education level
- Language barriers
- Disabilities or mental health barriers
It can be hard to sort out all these things. But there’s no question that health care disparities can lead to unnecessary complications in AFib. There are programs and doctors working to make health care access equal for everyone. Talk to your doctor, or someone at a medical clinic near you, about any problems you’re having with things like getting to your appointments or paying for your AFib medications.
