Key result
Non-English primary language is linked to a ~48% lower likelihood of receiving pre-stroke AF anticoagulation.
Why the study?
Many patients presenting with stroke and known AF are not anticoagulated, and the association between language barriers and initiation of anticoagulation therapy for AF remains uncertain.
Does having a non-English primary language reduce the likelihood of being initiated on anticoagulation for known atrial fibrillation prior to stroke?
Cohort (n=6,829)
Yes
Does having a non-English primary language reduce the likelihood of being initiated on anticoagulation for known atrial fibrillation prior to stroke?
Effect estimate: OR 0.52 (95% CI 0.36-0.77)
p-value: p=0.001
Non-English primary language is significantly associated with a lower likelihood of receiving guideline-directed anticoagulation for atrial fibrillation prior to an ischaemic stroke.
Non-English primary language may signal anticoagulation disparities in known AF; this Level 3 cohort leaves open causal mechanisms and equity interventions.
BACKGROUND: Anticoagulation can prevent most strokes in individuals with atrial fibrillation (AF); however, many people presenting with stroke and known AF are not anticoagulated. Language barriers and poor health literacy have previously been associated with decreased patient medication adherence. The association between language barriers and initiation of anticoagulation therapy for AF is uncertain. AIMS: The aims of this study were to determine whether demographic factors, including non-English primary language, were (1) associated with not being initiated on anticoagulation for known AF prior to admission with stroke, and (2) associated with non-adherence to anticoagulation in the setting of known AF prior to admission with stroke. METHODS: A multicentre retrospective cohort study was conducted for consecutive individuals admitted to the three South Australian tertiary hospitals with stroke units over a 5-year period. RESULTS: There were 6829 individuals admitted with stroke. These cases included 5835 ischaemic stroke patients, 1333 of whom had pre-existing AF. Only 40.0% presenting with ischaemic stroke in the setting of known pre-existing AF were anticoagulated. When controlling for demographics, socioeconomic status and past medical history (including the components of the CHADS2VASC score and anticoagulation contraindications), having a primary language other than English was associated with a lower likelihood of having been commenced on anticoagulant for known pre-stroke AF (odds ratio: 0.52, 95% confidence interval: 0.36-0.77, P = 0.001), but was not associated with a differing likelihood of anticoagulation adherence. CONCLUSIONS: A significant proportion of patients with stroke have pre-existing unanticoagulated AF; these rates are substantially higher if the primary language is other than English. Targeted research and interventions to minimise evidence-treatment gaps in this cohort may significantly reduce stroke burden.
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Bacchi et al. (2023) conducted a cohort in Atrial fibrillation and stroke (n=6,829). Non-English primary language vs. English primary language was evaluated on Initiation of anticoagulation for known atrial fibrillation prior to admission with stroke (OR 0.52, 95% CI 0.36-0.77, p=0.001). A non-English primary language was associated with a lower likelihood of receiving anticoagulation for known atrial fibrillation prior to stroke admission (OR 0.52; 95% CI 0.36-0.77; P=0.001).
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