Associations between clinical and social factors and anticoagulant prescription among patients with atrial fibrillation: A retrospective cohort study from a large healthcare system

Figures

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  Fig 1. Patient flow diagram. AF, atrial fibrillation; VTE, venous thromboembolism.

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  Fig 2. Class of anticoagulant prescribed and aspirin use by CHA2DS2-VASc scorea. CHA2DS2-VASc, congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category; DOAC, direct-acting oral anticoagulant; OAC, oral anticoagulant. All study patients with scores between 2–8 were included in this analysis (N = 12,533). a Anticoagulant care is recommended for CHA2DS2-VASc scores ≥2.

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  Fig 3. Relationship between diagnosing and prescribing providers among patients recently diagnosed with AF. AF, atrial fibrillation; OAC, oral anticoagulant. All study patients were included in this analysis (N = 16,656). a Primary care includes internal medicine, geriatrics, family medicine, and pediatrics. b Other includes nurse practitioner/physician assistant (unspecified), other, or missing.

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  Fig 4. National ADIa among patients diagnosed with AF and (A) anticoagulant prescription and (B) class prescribed. ADI, area deprivation index; AF, atrial fibrillation; DOAC, direct-acting oral anticoagulant; OAC, oral anticoagulant. Fig 4A includes all patients (N = 16,159) included in this study who had an ADI score. Fig 4B was limited to patients who were prescribed an OAC and had an ADI score (N = 10,575 patients). a ADI scores range from 1 (least socioeconomically disadvantaged) to 100 (most socioeconomically disadvantaged) and is missing for some patients.

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  Fig 5. Association between SDOH domains, associated behaviors, and anticoagulant prescription within 1 year of AF diagnosis. AF, atrial fibrillation; CHA2DS2-VASc, congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category; HAS-BLED, hypertension, abnormal liver/renal function, stroke history, bleeding history or predisposition, elderly, drug/alcohol use; RR, relative risk; SDOH, social determinants of health. A total of 16,124 patients had data on all independent variables and were included in this regression model. a Percentage reflects the proportion of the population within a category. b Covariates in the model included insurance status, marital status, preferred language, race/ethnicity, religion, history of alcoholism, smoking status, age, sex, hypertension, stroke, transient ischemic attack, myocardial infarction, chronic kidney disease, congestive heart failure, venous thromboembolism, diabetes, diagnosing provider, CHA2DS2-VASc score, HAS-BLED score, and cluster for area deprivation index.

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  Fig 6. Association between SDOH domains, associated behaviors, and class of anticoagulant prescribed (DOAC vs warfarin). CHA2DS2-VASc, congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category; DOAC, direct-acting oral anticoagulant; HAS-BLED, hypertension, abnormal liver/renal function, stroke history, bleeding history or predisposition, elderly, drug/alcohol use; RR, relative risk; SDOH, social determinants of health. This analysis was limited to patients who were prescribed an OAC (N = 10,575), of which 10,558 patients had data on all independent variables and were included in these regression models. a Percentage reflects the proportion of the population within a category. b Covariates in the model included insurance status, marital status, preferred language, race/ethnicity, religion, history of alcoholism, smoking status, age, sex, hypertension, stroke, transient ischemic attack, myocardial infarction, chronic kidney disease, congestive heart failure, venous thromboembolism, diabetes, diagnosing provider, CHA2DS2-VASc score, HAS-BLED score, and cluster for area deprivation index.