Urban-rural disparities in the prevalence and management of atrial fibrillation in elderly chinese

Objective: Atrial fibrillation is a common cardiac arrhythmia in the elderly. This study aimed to evaluate urban-rural disparities in its prevalence and management in elderly Chinese. Design and method: Consecutive participants aged above 65 years attending outpatient clinics were enrolled for atrial fibrillation screening using handheld single-lead electrocardiogram (ECG, BP7900, Omron Healthcare, Kyoto, Japan and Kardia Mobile®, Mountain View, California, USA) from April 2017 to December 2022 (NCT04111419). Each ECG rhythm strip was reviewed form the research team. Atrial fibrillation or uninterpretable single-lead ECGs were referred for 12-lead ECG. Blood pressure was measured 3 times consecutively with a 30-60 seconds interval using an automated oscillometric blood pressure monitor (HEM-9200T; Omron Healthcare, Kyoto, Japan). Results: The mean age of the 29,166 participants was 72.2±5.8 years, and 54.6% were women. The overall prevalence of atrial fibrillation was 4.6% (n = 1347). Atrial fibrillation was more prevalent in 7073 rural than 22093 urban participants (5.6% vs. 4.3%, P<0.0001). Multivariate logistic regression analysis identified that overweight/obesity (odds ratio [OR], 1.35; 95% confidence interval [CI] 1.17 to 1.54) in urban areas, whereas current smoking (OR, 1.62; 95% CI 1.20 to 2.17) and alcohol consumption (OR, 1.42; 95% CI 1.04 to 1.93) in rural areas were specific risk factors for prevalent atrial fibrillation. In patients with known atrial fibrillation in urban (n = 781) and rural areas (n = 338), 60.6% and 45.9%, respectively, received atrial fibrillation treatment (P<0.0001), and only 22.4% and 17.2%, respectively, received anticoagulation therapy (P = 0.047). Similar proportions of atrial fibrillation patients in urban and rural areas had concomitant hypertension (78.1%). However, in patients with known atrial fibrillation and treated hypertension, systolic/diastolic blood pressure was significantly (P< = 0.01) higher in rural (n = 475, 140.0/83.9 mmHg) than urban areas (n = 222, 135.7/79.0 mmHg). Conclusions: In China, there are urban-rural disparities in atrial fibrillation in the elderly, with a higher prevalence and worse management in rural than urban areas.