Key result
Black and Mixed/Multiple ethnic groups and patients aged 18-74 years with atrial fibrillation and high stroke risk were less likely to be prescribed anticoagulation.
Why the study?
Stroke prevention is essential in AF but some patients receive sub-optimal management, prompting evaluation against national guidance recommending anticoagulation for CHA2DS2-VASc stroke risk score 2 or higher to identify potential inequalities.
Cross-Sectional (n=2,913)
Yes
There are significant age and ethnic inequities in the prescribing of anticoagulation for stroke prevention in patients with atrial fibrillation, highlighting a gap in guideline-directed care.
Signals potential inequities in AF anticoagulation prescribing; cross-sectional data leaves open causal mechanisms and intervention targets.
BACKGROUND: Stroke prevention is essential for patients with atrial fibrillation (AF), but some receive sub-optimal management. We reviewed those with a recorded AF diagnosis assessed with CHA2DS2-VASc stroke risk score (SRS) and socio-demographic determinants of anticoagulation prescribing. The objective was to compare with national guidance recommendations, which recommend anticoagulant therapy for SRS ≥ 2, to determine if there were inequalities in management. METHODS: A cross-sectional design was used to analyze records from all (n = 41) general practices in one London borough. Patients were excluded if they were <18 years, had AF resolved or diagnosed < 3 months. Logistic regression identified socio-demographic factors associated with high SRS and anticoagulant prescribing. RESULTS: Of 2913 patients, 2885 (99.0%) had an SRS, and 2411 (83.6%) a score ≥ 2 and 82.9% (1999 of 2411) were prescribed anticoagulation. Women (compared with men), Black and Mixed/Multiple ethnic groups (compared with White), and those living in most deprived areas (compared with least) were more likely to have a score ≥ 2. Patients with a high SRS from Black and Mixed/Multiple ethnic groups and aged 18-74 years were less likely to be prescribed anticoagulation. CONCLUSION: We found evidence of age and ethnic inequity in anticoagulation prescribing for stroke prevention in patients with AF.
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Wou et al. (2022) conducted a cross-sectional in atrial fibrillation (n=2,913). Socio-demographic factors (Black and Mixed/Multiple ethnicity, age 18-74 years) vs. White ethnicity, other age groups was evaluated on Anticoagulant prescribing in patients with CHA2DS2-VASc score ≥ 2. Black and Mixed/Multiple ethnic groups and patients aged 18-74 years with atrial fibrillation and high stroke risk were less likely to be prescribed anticoagulation.
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