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

Wei ZHANG; Yi CHEN; Lei-Xiao HU; Jia-Hui XIA; Xiao-Fei YE; Wen-Yuan-Yue WANG; Xin-Yu WANG; Quan-Yong XIANG; Qin TAN; Xiao-Long WANG; Xiao-Min YANG; De-Chao ZHAO; Xin CHEN; Yan LI; Ji-Guang WANG; for the IMPRESSION Investigators and Coordinators

doi:10.26599/1671-5411.2025.02.001

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 hand-held single-lead electrocardiogram (ECG) from April 2017 to December 2022. Each ECG rhythm strip was reviewed by 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 7,073 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=1,347). AF was more prevalent in 7,073 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.