Atrial electrical and structural remodeling: implications for racial differences in atrial fibrillation.

Racial Disparity in AF Electrophysiology. Racial differences in prevalence and incidence rates of atrial fibrillation (AF) are known to exist even after accounting for ascertainment bias, as well as differences in the prevalence of known risk factors. Thus, a different susceptibility to traditional risk factors in different ethnic groups that lead to AF clearly exists. Initiation and maintenance of AF are dependent on triggers, autonomic influence and atrial substrate, and progression to persistent AF occurs by electromechanical remodeling. Genetic differences among the racial group contribute to such differences. This article reviews the electrophysiologic mechanisms for AF, evidence for racial differences in susceptibility to AF, and suggests possible electromechanical reasons for the susceptibility.

The Association of Black Cardiologists (ABC) Cardiovascular Implementation Study (CVIS): A Research Registry Integrating Social Determinants to Support Care for Underserved Patients.

African Americans, other minorities and underserved populations are consistently under- represented in clinical trials. Such underrepresentation results in a gap in the evidence base, and health disparities. The ABC Cardiovascular Implementation Study (CVIS) is a comprehensive prospective cohort registry that integrates social determinants of health. ABC CVIS uses real world clinical practice data to address critical gaps in care by facilitating robust participation of African Americans and other minorities in clinical trials. ABC CVIS will include diverse patients from collaborating ABC member private practices, as well as patients from academic health centers and Federally Qualified Health Centers (FQHCs). This paper describes the rationale and design of the ABC CVIS Registry. The registry will: (1) prospectively collect socio-demographic, clinical and biospecimen data from enrolled adults, adolescents and children with prioritized cardiovascular diseases; (2) Evaluate the safety and clinical outcomes of new therapeutic agents, including post marketing surveillance and pharmacovigilance; (3) Support National Institutes of Health (NIH) and industry sponsored research; (4) Support Quality Measures standards from the Center for Medicare and Medicaid Services (CMS) and Commercial Health Plans. The registry will utilize novel data and technology tools to facilitate mobile health technology application programming interface (API) to health system or practice electronic health records (EHR). Long term, CVIS will become the most comprehensive patient registry for underserved diverse patients with cardiovascular disease (CVD) and co morbid conditions, providing real world data to address health disparities. At least 10,000 patients will be enrolled from 50 sites across the United States.