Date of Award

2023-08-10

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, Ph.D., RN, FAAN, Chairperson Caroline Etland, Ph.D., RN, CNS, ACHPN, Committee Member Allon Rafael, MD, Committee Member

Keywords

atrial fibrillation in Hispanics, social determinants of health (SDOH) in Hispanics, Health Equity in Hispanics with atrial fibrillation

Abstract

Background: Research has found atrial fibrillation (AF) to be the primary or a contributing cause of death on 183,321 death certificates, and an underlying cause of death for 26,535 Americans in 2019. Findings indicate an increased AF diagnosis in White people compared to racial and ethnic minorities, contrasting widespread findings of increased prevalence of cardiovascular disease and ischemic strokes in minorities. Significant disparities—by race and socioeconomic status in disease distribution and access to testing and lifesaving treatments—have been documented, specifically associated with social determinants of health (SDOH); i.e., the conditions in which people are born, grow, live, work, and age. The Hispanic population is the second-largest ethnic group, comprising 18.7% of the total population, nonetheless, few studies describe AF diagnosis, treatment, and outcomes in Hispanics (Linares et al., 2019).

Purpose/Aims: To explore the SDOH, select sociodemographics, and symptom burden in Hispanic/Latino adults compared to non-Hispanic/Latino adults with AF who obtain rhythm and rate control treatment.

Methods: A cross-sectional correlational design was used. Data was extracted from the electronic health record of 750 participants receiving treatment for AF between June 2020 and June 2022. Inclusion criteria: Age 21 years and older, gender (males, females, other), and ECG-confirmed AF. Measurements: Age, race, ethnicity, gender, health plan, body mass index, hypertension diagnosis, smoking, alcohol use, admitting/primary/ secondary diagnoses, type of AF diagnosis, employment status, access to healthcare, type of community, AF treatment (rhythm, rate control), reported symptoms.

Data Analysis: Descriptive (frequencies, measures of dispersion) and inferential statistics, including bivariate (chi-square tests and t-tests) and multivariate (binomial logistic regression) analyses.

Findings: Select clinical findings were not significantly associated with ethnicity (e.g., smoking status, admitting/primary/secondary diagnoses, or diagnoses of hypertension were not associated with ethnicity). Alcohol use was greater in non-Hispanics, and being overweight, obese, and morbidly obese was greater in Hispanics. Hispanic participants were younger than non-Hispanic participants. Ethnicity was not significantly associated with any of the AF pharmacological and non-pharmacological care treatments evaluated in this study (i.e., in-hospital antiarrhythmic drugs, in-hospital rate control drugs, prior catheter ablation, prior surgical ablation, and cardioversion).

Implications for Research: The American Association of Colleges of Nursing goals for nurses include addressing pervasive inequities in healthcare to meet the needs of all individuals. Studies have found great variability in AF symptomology, and current treatment guidelines recommend clinical treatment decisions based on a patient’s symptoms. Findings from this study will inform and guide treatment strategies for Hispanics with AF. The study revealed disparities in healthcare. In this cohort, Hispanics traveled longer distances for care, sought care at an earlier age, and had catheter ablations more frequently than non-Hispanics; obesity was a prevalent comorbidity among Hispanics.

Document Type

Dissertation: Open Access

Department

Nursing

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