Exploring urban versus rural disparities in atrial fibrillation: prevalence and management trends among elderly Chinese in a screening study

Wei ZHANG^¹, Yi CHEN^¹, Lei-Xiao HU^¹, Jia-Hui XIA^¹, Xiao-Fei YE^¹, Wen-Yuan-Yue WANG^¹, Xin-Yu WANG^¹, Quan-Yong XIANG^², Qin TAN^³, Xiao-Long WANG^⁴, Xiao-Min YANG^⁵, De-Chao ZHAO^⁶, Xin CHEN^¹, Yan LI^¹, Ji-Guang WANG^{¹^,⁷}(), for the IMPRESSION Investigators and Coordinators

Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

Department of Chronic Non-communicable Disease Control, Jiangsu Province Center for Disease Control and Prevention, Nanjing, China

Shanghai Pudong New Area Sanlinkangde Community Health Center, Shanghai, China

Department of Cardiology, People's Hospital of Hongsibao District, Ningxia, China

General Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Zhejiang, China

Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China

National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Abstract

BACKGROUND

Atrial fibrillation (AF) is a common cardiac arrhythmia in the elderly. This study aimed to evaluate urban-rural disparities in its prevalence and management in elderly Chinese.

METHODS

Consecutive participants aged ≥ 65 years attending outpatient clinics were enrolled for AF screening using handheld single-lead electrocardiogram (ECG) from April 2017 to December 2022. Each ECG rhythm strip was reviewed from the research team. AF or uninterpretable single-lead ECGs were referred for 12-lead ECG. Primary study outcome comparison was between rural and urban areas for the prevalence of AF. The Student’s t-test was used to compare mean values of clinical characteristics between rural and urban participants, while the Pearson’s chi-square test was used to compare between-group proportions. Multivariate stepwise logistic regression analysis was performed to estimate the association between AF and various patient characteristics.

RESULTS

The 29,166 study participants included 13,253 men (45.4%) and had a mean age of 72.2 years. The 7073 rural participants differed significantly (P ≤ 0.02) from the 22,093 urban participants in several major characteristics, such as older age, greater body mass index, and so on. The overall prevalence of AF was 4.6% (n = 1347). AF was more prevalent in 7073 rural participants than 22,093 urban participants (5.6% vs. 4.3%, P < 0.01), before and after adjustment for age, body mass index, blood pressure, pulse rate, cigarette smoking, alcohol consumption and prior medical history. Multivariate logistic regression analysis identified overweight/obesity (OR = 1.35, 95% CI: 1.17–1.54) in urban areas and cigarette smoking (OR = 1.62, 95% CI: 1.20–2.17) and alcohol consumption (OR = 1.42, 95% CI: 1.04–1.93) in rural areas as specific risk factors for prevalent AF. In patients with known AF in urban areas (n = 781) and rural areas (n = 338), 60.6% and 45.9%, respectively, received AF treatment (P < 0.01), and only 22.4% and 17.2%, respectively, received anticoagulation therapy (P = 0.05).

CONCLUSIONS

In China, there are urban-rural disparities in AF in the elderly, with a higher prevalence and worse management in rural areas than urban areas. Our study findings provide insight for health policymakers to consider urban-rural disparity in the prevention and treatment of AF.

Electronic Supplementary Material

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References

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Elliott AD, Middeldorp ME, Van Gelder IC, et al. Epidemiology and modifiable risk factors for atrial fibrillation. Nat Rev Cardiol 2023; 20: 404−417.