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.