The following is the summary of “Racial Differences in Atrial Fibrillation Management Between White Patients and Black Patients in Transthyretin Cardiac Amyloid” published in the January 2023 issue of Cardiovascular Disease by Mitrani, et al.

Stroke incidence is greater in the Black community than in the White community. In a strange twist, White people are twice as likely as Black people to develop atrial fibrillation (AF). AF and strokes are both linked to transthyretin cardiac amyloidosis (ATTR-CA). Although Black individuals with ATTR-CA have a lower AF incidence, researchers expected they would be more likely to experience thromboembolic events if diagnosed with AF. Patients with ATTR-CA (n=558) were identified retrospectively from 3 worldwide centers. 

Researchers examined racial groups based on demographic data, including significant bleeding, mortality, and thromboembolic events (stroke, TIA, and PE). There were 367 cases of AF among 488 White patients (75%) and 39 cases among 70 Black patients (56%; P=0.001). A first thromboembolic event occurred 5.78 times more often among Black patients with AF than White patients (95% confidence interval, 2.30 to 14.50). When it came to severe bleeding, no racial differences were observed. However, lack of anticoagulation was more common in black patients with AF (P=0.038), and the labile international normalized ratio was more common in black patients with AF (P<0.001). 

While Black patients with ATTR-CA have a lower incidence of AF but have an elevated risk of thromboembolic events compared to White patients, according to these findings, differences in treatment, length of time in the therapeutic range for warfarin, and healthcare inequalities may all contribute to these results.