Accepted for Publication: September 26, 2022.
Published Online: December 7, 2022. doi:10.1001/jamacardio.2022.4091
Corresponding Author: Emelia J. Benjamin, MD, ScM, Cardiovascular Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Collamore 8, 72 E Concord St, Boston, MA 02118 (emelia@bu.edu).
Author Contributions: Drs Benjamin and Thomas had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Benjamin, Thomas, Go, Desvigne-Nickens, Alonso, Chamberlain, Essien, Levy, Magnani, Matlock, O’Brien, Cooper, Al-Khatib.
Acquisition, analysis, or interpretation of data: Benjamin, Thomas, Go, Albert, Hernandez, Hills, Kershaw, Rodriguez, Russo, Soliman, Al-Khatib.
Drafting of the manuscript: Benjamin, Thomas, Albert, Alonso, Essien, Kershaw, Magnani, Matlock, Rodriguez, Russo, Soliman.
Critical revision of the manuscript for important intellectual content: Benjamin, Go, Desvigne-Nickens, Albert, Alonso, Chamberlain, Essien, Hernandez, Hills, Kershaw, Levy, Magnani, Matlock, O’Brien, Rodriguez, Russo, Soliman, Cooper, Al-Khatib.
Administrative, technical, or material support: Benjamin, Thomas, Go, Desvigne-Nickens, Magnani, Cooper.
Study supervision: Benjamin, Thomas, Cooper.
Conflict of Interest Disclosures: Dr Benjamin reported research funding from the National Heart, Lung, and Blood Institute, the National Institute of Aging, and the American Heart Association. Dr Thomas is an advisor to Johnson & Johnson and Biosense Webster; is a consultant for Pfizer and Bristol Myers Squibb; and is a steering committee member for the REACT-AF trial. Dr Go is a member of the operations committee and steering committee for the Study to Determine if Identification of Undiagnosed Atrial Fibrillation in People at Least 70 Years of Age Reduces the Risk of Stroke, sponsored by Bristol Meyers Squibb and Pfizer; has received research funding through his institution from Bristol Meyers Squibb, iRhythm Technologies, and Janssen; and reports grants from the National Heart, Lung and Blood Institute and iRhythm Technologies through his institution during the conduct of the study. Dr Albert is a member of the data safety and monitoring board for the Apple Watch Study and is on the steering committee for the CHANGE AF study. Dr Alonso reported grants from the National Institutes of Health during the conduct of the study. Dr Chamberlain reported grants from the National Institute on Aging and from Patient Centered Outcomes Research Institute paid to her institution during the conduct of the study. Dr Essien reported grants from Department of Veterans Affairs outside the submitted work. Dr Hernandez reports serving as a consultant to Pfizer and Bristol Myers Squibb. Dr Levy is immediate past chair of the accreditation oversight committee and current member of the National Cardiovascular Data Registry oversight committee at the American College of Cardiology and president of the Southeast Michigan American Heart Association. Dr Magnani reported grants from the National Heart, Lung, and Blood Institute outside the submitted work. Dr O’Brien reports research grants to her institution from Pfizer, Bristol Myers Squibb, and Novartis. Dr Rodriguez has received honoraria from Merck, grant support from the American Heart Association and the National Institutes of Health, and research support from Amgen and has served on an advisory board for Amgen. Dr Russo has served as a consultant for Abbott, Atricure, Biosense Webster, Medtronic, and PaceMate; served on research steering committees for Bayer, Boston Scientific, and Medtronic; received grants for research from Boston Scientific, Bristol Meyers Squibb–Pfizer, Kestra, Medilynx, and Medtronic; and received honoraria from Biotronik, Bristol Meyers Squibb–Pfizer, Medtronic, Sanofi, and the American Board of Internal Medicine outside the submitted work. Dr Al-Khatib has received research funding from Medtronic, Boston Scientific, and Abbott outside the submitted work. No other disclosures were reported.
Funding/Support: Dr Benjamin receives research funding from National Heart, Lung, and Blood Institute grants R01HL128914, 2R01HL092577, and R01HL141434 01A1; National Institute of Aging grant R01AG066010; and American Heart Association grant 18SFRN34110082. Dr Thomas reports funding from Patient Centered Outcomes Research Institute grant 1503-29746 and US National Institutes of Health grants 5UL1-TR001117-03, 1R01-MD013493-01, 1R01-MD011606-03, 5U54MD012530-03, and 5R25HL135304-05. Dr Go receives research funding from National Heart, Lung, and Blood Institute grant R01HL142834 and National Institute of Diabetes and Digestive and Kidney Diseases grant R01DK103612. Dr Albert receives research funding from National Heart, Lung, and Blood Institute grant R01HL116690. Dr Essien receives research funding from Veterans Health Administration grant IK2HX003176. Dr Hernandez receives research funding from National Heart, Lung, and Blood Institute grants R01HL157051 and K01HL142847. Dr Kershaw receives research funding from National Institute of Aging grants 5R01AG67557, 5R01AG062180, and 1R21AG069435 and American Heart Association grant 22HERNPMI985236. Dr Levy receives research funding from National Heart, Lung, and Blood Institute grants R01 HL153607, R01 HL163377, R01 HL146059, R01 HL127215, and T32 HL120822; National Institute of Minority Health and Health Disparities grant P50 MD017351; and the American Heart Association Health Equity Research Network. Dr Magnani receives research funding from National Heart, Lung, and Blood Institute grants R01HL143010, R33HL144669, and K24HL160527. Dr Rodriguez receives funding from the National Heart, Lung, and Blood Institute and the American Heart Association. Dr Alonso receives funding from National Heart, Lung, and Blood Institute grants K24HL148521 and R01HL137338 and American Heart Association grant 16EIA26410001. Dr Kershaw receives research funding from National Institute on Aging grants R01AG067557, R01AG062180, and R21AG069435. Dr Chamberlain receives funding from National Institute on Aging grants R21AG62580 and R21AG64804 and Patient Centered Outcomes Research Institute grant RI-CRN-2020-009.
Role of the Funder/Sponsor: The funders reviewed the manuscript to confirm policy compliance but had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the US Department of Health and Human Services.
1.Havranek
EP , Mujahid
MS , Barr
DA ,
et al; American Heart Association Council on Quality of Care and Outcomes Research, Council on Epidemiology and Prevention, Council on Cardiovascular and Stroke Nursing, Council on Lifestyle and Cardiometabolic Health, and Stroke Council. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association.
Circulation. 2015;132(9):873-898. doi:
10.1161/CIR.0000000000000228PubMedGoogle ScholarCrossref 4.Al-Khatib
SM , Benjamin
EJ , Albert
CM ,
et al. Advancing research on the complex interrelations between atrial fibrillation and heart failure: a report from a US National Heart, Lung, and Blood Institute virtual workshop.
Circulation. 2020;141(23):1915-1926. doi:
10.1161/CIRCULATIONAHA.119.045204PubMedGoogle ScholarCrossref 5.Al-Khatib
SM , Benjamin
EJ , Buxton
AE ,
et al; Workshop Collaborators. Research needs and priorities for catheter ablation of atrial fibrillation: a report from a National Heart, Lung, and Blood Institute virtual workshop.
Circulation. 2020;141(6):482-492. doi:
10.1161/CIRCULATIONAHA.119.042706PubMedGoogle ScholarCrossref 7.Benjamin
EJ , Al-Khatib
SM , Desvigne-Nickens
P ,
et al. Research priorities in the secondary prevention of atrial fibrillation: a National Heart, Lung, and Blood Institute virtual workshop report.
J Am Heart Assoc. 2021;10(16):e021566. doi:
10.1161/JAHA.121.021566PubMedGoogle ScholarCrossref 12.Gurusamy
VK , Brobert
G , Vora
P , Friberg
L . Sociodemographic factors and choice of oral anticoagulant in patients with non-valvular atrial fibrillation in Sweden: a population-based cross-sectional study using data from national registers.
BMC Cardiovasc Disord. 2019;19(1):43. doi:
10.1186/s12872-019-1029-zPubMedGoogle ScholarCrossref 14.Magnani
JW , Mujahid
MS , Aronow
HD ,
et al; American Heart Association Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Stroke Council. Health literacy and cardiovascular disease: fundamental relevance to primary and secondary prevention: a scientific statement from the American Heart Association.
Circulation. 2018;138(2):e48-e74. doi:
10.1161/CIR.0000000000000579PubMedGoogle ScholarCrossref 18.Kutner
M , Greenberg
E , Jin
Y , Paulsen
C . The health literacy of America’s adults: results from the 2003 National Assessment of Adult Literacy. Accessed June 12, 2022.
https://nces.ed.gov/pubs2006/2006483.pdf 19.Schillinger
D . The intersections between social determinants of health, health literacy, and health disparities.
Stud Health Technol Inform. 2020;269:22-41. doi:
10.3233/SHTI200020PubMedGoogle Scholar 21.Cabellos-García
AC , Martínez-Sabater
A , Castro-Sánchez
E , Kangasniemi
M , Juárez-Vela
R , Gea-Caballero
V . Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review.
BMC Public Health. 2018;18(1):1157. doi:
10.1186/s12889-018-6070-9PubMedGoogle ScholarCrossref 24.Golwala
H , Jackson
LR
II , Simon
DN ,
et al; Outcomes Registry for Better Informed Treatment for Atrial Fibrillation (ORBIT-AF) Registry. Racial/ethnic differences in atrial fibrillation symptoms, treatment patterns, and outcomes: insights from Outcomes Registry for Better Informed Treatment for Atrial Fibrillation registry.
Am Heart J. 2016;174:29-36. doi:
10.1016/j.ahj.2015.10.028PubMedGoogle ScholarCrossref 27.Rodriguez
CJ , Soliman
EZ , Alonso
A ,
et al. Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis.
Ann Epidemiol. 2015;25(2):71-76, 76.e1. doi:
10.1016/j.annepidem.2014.11.024PubMedGoogle ScholarCrossref 28.Churchwell
K , Elkind
MSV , Benjamin
RM ,
et al; American Heart Association. Call to action: structural racism as a fundamental driver of health disparities: a presidential advisory from the American Heart Association.
Circulation. 2020;142(24):e454-e468. doi:
10.1161/CIR.0000000000000936PubMedGoogle ScholarCrossref 29.Lett
E , Asabor
E , Beltrán
S , Cannon
AM , Arah
OA . Conceptualizing, contextualizing, and operationalizing race in quantitative health sciences research.
Ann Fam Med. 2022;20(2):157-163. doi:
10.1370/afm.2792PubMedGoogle ScholarCrossref 35.Khan
MZ , Munir
MB , Khan
SU ,
et al. Representation of women, older patients, ethnic, and racial minorities in trials of atrial fibrillation.
Pacing Clin Electrophysiol. 2021;44(3):423-431. doi:
10.1111/pace.14178PubMedGoogle ScholarCrossref 36.Ðoàn
LN , Takata
Y , Sakuma
KK , Irvin
VL . Trends in clinical research including Asian American, Native Hawaiian, and Pacific Islander participants funded by the US National Institutes of Health, 1992 to 2018.
JAMA Netw Open. 2019;2(7):e197432. doi:
10.1001/jamanetworkopen.2019.7432PubMedGoogle ScholarCrossref 40.Piccini
JP , Simon
DN , Steinberg
BA ,
et al; Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators and Patients. Differences in clinical and functional outcomes of atrial fibrillation in women and men: two-year results from the ORBIT-AF registry.
JAMA Cardiol. 2016;1(3):282-291. doi:
10.1001/jamacardio.2016.0529PubMedGoogle ScholarCrossref 41.Emdin
CA , Wong
CX , Hsiao
AJ ,
et al. Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies.
BMJ. 2016;532:h7013. doi:
10.1136/bmj.h7013PubMedGoogle ScholarCrossref 45.Lip
GY , Laroche
C , Boriani
G ,
et al. Sex-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Observational Research Programme pilot survey on atrial fibrillation.
Europace. 2015;17(1):24-31. doi:
10.1093/europace/euu155PubMedGoogle ScholarCrossref 46.Lindley
KJ , Aggarwal
NR , Briller
JE ,
et al; American College of Cardiology Cardiovascular Disease in Women Committee and the American College of Cardiology Health Equity Taskforce. Socioeconomic determinants of health and cardiovascular outcomes in women: JACC Review Topic of the Week.
J Am Coll Cardiol. 2021;78(19):1919-1929. doi:
10.1016/j.jacc.2021.09.011PubMedGoogle ScholarCrossref 48.Streed
CG
Jr , Beach
LB , Caceres
BA ,
et al; American Heart Association Council on Peripheral Vascular Disease; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology and Intervention; Council on Hypertension; and Stroke Council. Assessing and addressing cardiovascular health in people who are transgender and gender diverse: a scientific statement from the American Heart Association.
Circulation. 2021;144(6):e136-e148. doi:
10.1161/CIR.0000000000001003PubMedGoogle ScholarCrossref 51.Mark
DB , Anstrom
KJ , Sheng
S ,
et al; CABANA Investigators. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial.
JAMA. 2019;321(13):1275-1285. doi:
10.1001/jama.2019.0692PubMedGoogle ScholarCrossref 54.January
CT , Wann
LS , Alpert
JS ,
et al; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.
Circulation. 2014;130(23):e199-e267. doi:
10.1161/CIR.0000000000000041PubMedGoogle ScholarCrossref 56.Torres Roldan
VD , Brand-McCarthy
SR , Ponce
OJ ,
et al. Shared decision making tools for people facing stroke prevention strategies in atrial fibrillation: a systematic review and environmental scan.
Med Decis Making. 2021;41(5):540-549. doi:
10.1177/0272989X211005655PubMedGoogle ScholarCrossref 58.Kunneman
M , Branda
ME , Hargraves
IG ,
et al; Shared Decision Making for Atrial Fibrillation (SDM4AFib) Trial Investigators. Assessment of shared decision-making for stroke prevention in patients with atrial fibrillation: a randomized clinical trial.
JAMA Intern Med. 2020;180(9):1215-1224. doi:
10.1001/jamainternmed.2020.2908PubMedGoogle ScholarCrossref 59.Alden
DL , Friend
J , Schapira
M , Stiggelbout
A . Cultural targeting and tailoring of shared decision making technology: a theoretical framework for improving the effectiveness of patient decision aids in culturally diverse groups.
Soc Sci Med. 2014;105:1-8. doi:
10.1016/j.socscimed.2014.01.002PubMedGoogle ScholarCrossref 65.Wändell
P , Carlsson
AC , Gasevic
D , Sundquist
J , Sundquist
K . Neighbourhood socio-economic status and all-cause mortality in adults with atrial fibrillation: a cohort study of patients treated in primary care in Sweden.
Int J Cardiol. 2016;202:776-781. doi:
10.1016/j.ijcard.2015.09.027PubMedGoogle ScholarCrossref 68.Carlsson
AC , Wändell
P , Gasevic
D , Sundquist
J , Sundquist
K . Neighborhood deprivation and warfarin, aspirin and statin prescription: a cohort study of men and women treated for atrial fibrillation in Swedish primary care.
Int J Cardiol. 2015;187:547-552. doi:
10.1016/j.ijcard.2015.04.005PubMedGoogle ScholarCrossref 73.Bonaccio
M , Di Castelnuovo
A , Costanzo
S ,
et al. Life course socioeconomic status and risk of hospitalization for heart failure or atrial fibrillation in the Moli-Sani Study cohort.
Am J Epidemiol. 2021;190(8):1561-1571. doi:
10.1093/aje/kwab046PubMedGoogle ScholarCrossref 74.January
CT , Wann
LS , Calkins
H ,
et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons.
Circulation. 2019;140(2):e125-e151. doi:
10.1161/CIR.0000000000000665PubMedGoogle ScholarCrossref 75.Hindricks
G , Potpara
T , Dagres
N ,
et al; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC.
Eur Heart J. 2021;42(5):373-498. doi:
10.1093/eurheartj/ehaa612PubMedGoogle ScholarCrossref