Key result
Black and Asian patients with atrial fibrillation had significantly lower rates of guideline-recommended oral anticoagulation compared to White patients (70.8% and 68.3% vs. 73.1%, respectively).
Why the study?
Appropriate oral anticoagulation rates for AF patients with elevated thromboembolic risk remain as low as 50% nationally, prompting evaluation of variability by sex, ethnicity, and socioeconomic status.
Are there disparities by sex, ethnicity, and socioeconomic status in the receipt of guideline-recommended oral anticoagulation among patients with atrial fibrillation and elevated thromboembolic risk?
Cohort (n=9,513)
Are there disparities by sex, ethnicity, and socioeconomic status in the receipt of guideline-recommended oral anticoagulation among patients with atrial fibrillation and elevated thromboembolic risk?
Absolute Event Rate: 70.8% vs 73.1%
p-value: p=0.03
Within a large integrated healthcare system, guideline-recommended anticoagulation rates for atrial fibrillation were relatively high (71.7%) with no disparities by sex or socioeconomic status, though modest treatment gaps persisted for Black and Asian patients.
Clinicians must address anticoagulation inequities in Black and Asian AF patients; confirms persistent racial disparities in guideline adherence.
Background : Atrial Fibrillation (AF) is the leading cause of stroke, which can be reduced by 70% with appropriate oral anticoagulation (OAC) therapy. Nationally, appropriate anticoagulation rates for patients with AF with elevated thromboembolic risk are as low as 50% even across the highest stroke risk cohorts. This study aims to evaluate the variability of appropriate anticoagulation rates among patients by sex, ethnicity, and socioeconomic status within the Kaiser Permanente Mid-Atlantic States (KPMAS). Methods : This retrospective study investigated 9,513 patients in KPMAS’s AF registry with CHADS 2 score ≥2 over a 6-month period in 2021. Results : Appropriately anticoagulated patients had higher rates of diabetes, prior stroke, and congestive heart failure than patients who were not appropriately anticoagulated. There were no significant differences in anticoagulation rates between males and females (71.8% vs. 71.6%%, [OR] 1.01; 95% CI, 0.93-1.11; P=.76) nor by SES-SVI quartiles. There was a statistically significant difference between Blacks and Whites (70.8% vs. 73.1%, P=.03) and Asians and Whites (68.3% vs. 71.6%, P = .005). After adjusting for CHADS 2 , this difference persisted for blacks and whites with CHADS 2 scores of ≤3 (62.6% vs. 70.6%, P <.001) and for Asians and whites with CHADS 2 scores > 5 (68.0% vs. 79.3%, P<.001). Conclusions : Black and Asians may have differing rates of appropriate anticoagulation when compared with Whites. Characterizing such disparities is the first step towards addressing treatment gaps in AF.
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Malik et al. (2023) conducted a cohort in Atrial Fibrillation (n=9,513). Black race/ethnicity vs. White race/ethnicity was evaluated on Receipt of guideline-recommended oral anticoagulation (p=0.03). Black and Asian patients with atrial fibrillation had significantly lower rates of guideline-recommended oral anticoagulation compared to White patients (70.8% and 68.3% vs. 73.1%, respectively).
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