INTRODUCTION

Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice 1. Accumulating evidence suggest a strong link between sex, age and race with AF incidence 2, 3. Men have highest AF prevalance, with 20.9 out of 33.5 million AF patients (62.4%) worldwide being men 4. Despite the lower prevalence, women are at a greater risk for more devastating AF-related consequences such as stroke 5-7. Also, it is well documented that the incidence, prevalence, and complications from AF increase with advancing age 8, 9. With regards to race-based differences, non-White population has been found to have a lower prevalence of AF compared with Whites10-12. Despite these statistics there are concerns that women, older patients and ethnic/racial minorities are under-represented in randomized controlled trials (RCTs) of cardiovascular disease such as AF compared with their share of disease in the population 13. The under recruitment of women, older participants and ethnic/racial minorities in cardiovascular drug trials and heart failure trials has been examined in prior reports13-15; however, there is paucity of data regarding systematic assessment of these demographic subsets in RCTs of AF. Herein, we provide a systematic review on representation of women, older patients, ethnic/racial minorities and their time trends in published trials of AF from 1989-2019.