Why the study?
The study aimed to examine the association between socioeconomic factors and oral anticoagulation therapy initiation in high-risk AF patients, and whether inequities changed over time with evolving clinical guidelines.
Does socioeconomic status influence the initiation of oral anticoagulation therapy in patients with atrial fibrillation at high risk of stroke?
Does socioeconomic status influence the initiation of oral anticoagulation therapy in patients with atrial fibrillation at high risk of stroke?
Socioeconomic inequalities in oral anticoagulation initiation for AF patients exist but may be mitigated by the implementation of more detailed clinical guidelines.
Socioeconomic disparities in OAC initiation for high-risk AF persist; supports partial guideline-driven reductions in education/cohabitation inequities while leaving income gaps open for intervention trials.
OBJECTIVE: The study aimed to examine the association between socioeconomic factors (SEFs) and oral anticoagulation (OAC) therapy and whether it was influenced by changing guidelines. We hypothesised that inequities in initiation of OAC reduced over time as more detailed and explicit clinical guidelines were issued. DESIGN: Register-based observational study. SETTINGS: All Danish patients with an incident hospital diagnosis of atrial fibrillation (AF), aged ≥30 years old and with high risk of stroke from 1 May 1999 to 2 October 2015 were included. Absolute risk differences (RD) (95% CI) were used to measure the association. PARTICIPANTS: 154 448 patients (mean age 78.2 years, men 47.3%). EXPOSURE: Education, family income and cohabiting status were the SEFs used as exposure. OUTCOME: A prescription of OAC within -30 to +90 days of baseline (incident AF). RESULTS: During 2002-2007, the crude RD of initiation of OAC for men with high education was 14.9% (12.8 to 16.9). Inequality reduced when new guidelines were published, and in 2013-2016 the crude RD was 5.6% (3.5 to 7.7). After adjusting for age, the RD substantially reduced. The same pattern was seen for cohabiting status, while inequality was smaller and more constant for income. CONCLUSION: Patients with low income, low education and living alone were associated with lower chance of being initiated with OAC. For education and cohabiting status, the crude difference reduced around 2011, when more detailed clinical guidelines were implemented in Denmark. Our results indicate that new guidelines might reduce inequality in OAC initiation and that new, high-cost drugs increase inequality.
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Lunde et al. (2021) studied this question.
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