Investigating the influence of ethnicity in Atrial Fibrillation, focusing on the epidemiology, risk factors and outcomes; a population based study.

Date of Approval
Application Number
21_000389
Technical Summary

Atrial Fibrillation (AF) is the most common arrhythmia seen in clinical practice, affecting approximately 1.4 million people in the UK.[1] AF is a major causative factor for ischaemic stroke.[2] Identifying patients with AF is vital for the prevention of stroke and its consequences. The CHA2DS2-VASc score is used to determine AF and stroke risk based on several risk factors.[3] As part of the interaction between ethnicity, AF and stroke we need to investigate differences in risk factors, compliance of prescription and dosing.

Rates of AF are lower amongst South Asians,[6,7,8] despite having many of the established risk factors for AF. It has also been shown that there are fewer pacemakers and implantable cardioverter defibrillators being implanted in South Asians.[9,10] Suggestions as to why the prevalence of AF is lower than expected in South Asians include a lower attendance to medical services.[7,8,11] There may also be a genuine lower incidence of AF in South Asians despite a similar (or worse) risk factor profile compared to Caucasians. More importantly, stroke rate is high in South Asians. Therefore the mechanisms underlying the interactions between risk factors in the causation of stroke may be different in different ethnicities.

This will be an observational cohort study of individuals with and without a diagnosis of AF and of South Asian, African Caribbean and Caucasian ethnicity. Poisson regression will assess whether AF incidence and the co-morbidities associated with AF, differ between ethnicities. Survival models will investigate the association between AF and subsequent risk of heart failure, TIA, stroke or mortality. An interaction between AF and ethnicity will be included to explore whether risk of events and AF differs by ethnicity. To investigate disruptions to AF detection and management as a result of COVID-19 pandemic, we will employ an interrupted time series analysis framework, stratified by ethnic group.

Health Outcomes to be Measured

Atrial fibrillation, transient ischemic attack (TIA), myocardial infarction, ischemic stroke, heart failure, mortality, prescription (and pick-up) of oral anticoagulants (both warfarin and non-vitamin K OACs) and antiarrythmic drugs, referral rates for pacemakers and implantable cardioverter defibrillators, hospital admissions, diagnosis of COVID-19.

Collaborators

G. Andre Ng - Chief Investigator - University of Leicester
Tom Norris - Corresponding Applicant - University of Leicester
Akash Mavilakandy - Collaborator - University of Leicester
Bharat Sidhu - Collaborator - University of Leicester
Clare Gillies - Collaborator - University of Leicester
Francesco Zaccardi - Collaborator - University of Leicester
Kamlesh Khunti - Collaborator - University of Leicester
Nilesh Samani - Collaborator - University of Leicester
Zakariyya Vali - Collaborator - University of Leicester

Linkages

HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation