Area Deprivation Index and Oral Anticoagulation in New Onset Atrial Fibrillation

Q: What are the key findings of this study?

Residing in the highest quartile of Area Deprivation Index was associated with a 16% lower likelihood of receiving an oral anticoagulation prescription at 90 days after AF diagnosis (OR 0.84, 95% CI 0.75-0.95).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Incident non-valvular atrial fibrillation (n=20210). Intervention: Highest quartile of Area Deprivation Index (ADI 76-100) vs. Lowest quartile of Area Deprivation Index (ADI 1-25). Primary outcome: Receipt of oral anticoagulation prescription (warfarin or DOAC) at 90 days following diagnosis of AF (OR 0.84, 95% CI 0.75-0.95, p=<0.01).

Q: What does this research mean for the field?

Residing in the highest quartile of Area Deprivation Index is associated with a 16% lower likelihood of receiving an oral anticoagulation prescription at 90 days after incident atrial fibrillation diagnosis. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To examine the relationship between neighborhood socioeconomic deprivation measured by the Area Deprivation Index and the prescription of oral anticoagulation for stroke prevention in incident atrial fibrillation.

Toluwa Omole; Jianuhi Zhu; William Garrard; Floyd Thoma; Suresh Mulukutla; Annie McDermott; Brandon M. Herbert; Utibe R. Essien; Jared W. Magnani

doi:10.1016/j.ajpc.2022.100346

April 27, 2022American Journal of Preventive CardiologyOpen Access

Area Deprivation Index and Oral Anticoagulation in New Onset Atrial Fibrillation

View Full Paper

Ask AI

Bookmark

Share

Key result

Highest area deprivation linked to ~16% lower likelihood of oral anticoagulation prescription after AF diagnosis.

OR 0.84
95% CI 0.75-0.95
P<0.01
n=20,210

Figures

Why the study?

Social determinants of health have had limited investigation in AF, particularly regarding access to oral anticoagulation for stroke prevention.

Does higher neighborhood social deprivation (Area Deprivation Index) reduce the likelihood of receiving an oral anticoagulation prescription at 90 days in patients with new-onset non-valvular atrial fibrillation?

Key Points

To examine the relationship between neighborhood socioeconomic deprivation measured by the Area Deprivation Index and the prescription of oral anticoagulation for stroke prevention in incident atrial fibrillation.
Retrospective analysis of 20,210 individuals (age 74.5±10.9 years; 51% women; 94% white) with incident, non-valvular atrial fibrillation from 2015 to 2020 at a large, regional health center.
Ascertained residential Area Deprivation Index (ADI) and evaluated receipt of oral anticoagulation (warfarin or direct-acting oral anticoagulant [DOAC]) at 90 days following diagnosis using multivariable-adjusted models.
Individuals in the highest ADI quartile had a 16% lower likelihood of receiving an anticoagulation prescription than those in the lowest quartile (OR 0.84; 95% CI, 0.75-0.95) at 90 days following diagnosis.
Among individuals prescribed anticoagulation, those in the highest ADI quartile had a 24% lower likelihood of receiving a DOAC rather than warfarin compared to the lowest quartile (OR 0.76; 95% CI, 0.60-0.96).
Overall, 65.3% (95% CI, 63.0-67.6) of patients in the lowest ADI quartile received any anticoagulation at 90 days compared with 61.5% (95% CI, 60.1-62.8) in the highest ADI quartile.

Study Design

Type

Cohort (n=20,210)

Multicenter

Yes

Structured PICO

Does higher neighborhood social deprivation (Area Deprivation Index) reduce the likelihood of receiving an oral anticoagulation prescription at 90 days in patients with new-onset non-valvular atrial fibrillation?

P

Population

20,210 adults (mean age 74.5 years, 50.8% female) with incident non-valvular atrial fibrillation and a CHA2DS2-VASc score >=2 receiving care in a regional US health care system, followed for 90 days for anticoagulation prescription.

E

Exposure

Residence in neighborhoods with higher social deprivation as measured by the Area Deprivation Index (ADI), specifically the highest ADI quartile (ADI 76-100, n=4,930)

C

Comparator

Residence in neighborhoods in the lowest quartile of Area Deprivation Index (ADI 1-25, least deprivation, n=1,605)

O

Outcome

Receipt of prescribed oral anticoagulation (warfarin or direct-acting oral anticoagulant [DOAC]) at 90 days following AF diagnosis, determined by review of electronic health record medication lists

Main Result

Odds Ratio: 0.84 (95% CI 0.75–0.95)

Absolute Event Rate: 61.5% vs 65.3%

p-value: p=<0.01

Patients with new-onset atrial fibrillation living in the most socioeconomically deprived neighborhoods have a 16% lower odds of being prescribed guideline-recommended oral anticoagulation and a 24% lower odds of receiving a DOAC over warfarin, highlighting significant neighborhood-level inequities in stroke prevention care.

Limitations

Potential misclassification of AF and clinical diagnoses due to reliance on administrative coding
ADI is a neighborhood-level measure and does not capture individual-level social factors such as personal wealth, education, or social support
Possibility that patients accessed oral anticoagulation outside of the studied health care system
Limited to a single regional health care system in Pennsylvania with a predominantly White population (94.3%), limiting generalizability
Data reflect prescription of oral anticoagulation in the electronic health record rather than medication initiation or longitudinal adherence
Potential residual confounding from unmeasured factors and unexamined provider-level differences
Use of administrative coding may result in misclassification of AF and clinical diagnoses
ADI is a neighborhood-level composite measure and does not reflect individual wealth, educational attainment, or social support
Potential for patients to access oral anticoagulation outside of the studied health care system
Limited to a single health care system in Pennsylvania without examination of provider-level differences, and 94.3% of individuals were of White race, limiting generalizability
Data capture electronic health record prescriptions rather than actual medication initiation or longitudinal adherence
Potential for residual confounding due to unmeasured factors

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May signal neighborhood barriers to AF anticoagulation; leaves open whether targeted interventions improve equitable prescribing.

Abstract

Objective: Oral anticoagulation is a standard of care for thromboembolic stroke prevention in individuals with atrial fibrillation (AF). Social determinants of health have had limited investigation in AF and particularly in access to anticoagulation. We examined the relation between area deprivation index (ADI) and anticoagulation in individuals at risk of stroke due to AF. Methods: We conducted a retrospective analysis of patients with incident, non-valvular AF from 2015-2020 receiving care at a large, regional health center. We extracted demographics, medications, and problem lists and used administrative coding to identify comorbid conditions and relevant covariates, and individual-level residential address to ascertain ADI. We examined the relation between ADI and receipt of prescribed oral anticoagulation (warfarin or direct-acting oral anticoagulant, or DOAC) at 90 days following AF diagnosis in multivariable-adjusted models. Results: Following exclusions, the dataset included 20,210 individuals (age 74.5±10.9 years; 51% women; 94% white race). In multivariable-adjusted analyses, individuals in the highest quartile of ADI had a 16% lower likelihood of receiving anticoagulation prescription than those in the lowest ADI quartile (Odds Ratio [OR] 0.84; 95% Confidence Interval [CI], 0.75-0.95) at 90 days following AF diagnosis. In those receiving anticoagulation, individuals in the highest ADI quartile had a 24% lower likelihood of receiving a DOAC prescription as opposed to warfarin prescription than those in the lowest quartile (OR 0.76; 95% CI, 0.60-0.96) at 90 days following AF diagnosis. Conclusions: We demonstrate the association of higher neighborhood deprivation as determined by ADI with decreased likelihood of (1) anticoagulation prescribing for stroke prevention in AF and (2) prescription of a DOAC when any oral anticoagulation is prescribed. Our results suggest neighborhood-based health inequities in the receipt of anticoagulation prescription for stroke prevention in AF in a large, regional health care system.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Omole et al. (2022) conducted a cohort in Incident non-valvular atrial fibrillation (n=20,210). Highest quartile of Area Deprivation Index (ADI 76-100) vs. Lowest quartile of Area Deprivation Index (ADI 1-25) was evaluated on Receipt of oral anticoagulation prescription (warfarin or DOAC) at 90 days following diagnosis of AF (OR 0.84, 95% CI 0.75-0.95, p=<0.01). Residing in the highest quartile of Area Deprivation Index was associated with a 16% lower likelihood of receiving an oral anticoagulation prescription at 90 days after AF diagnosis (OR 0.84, 95% CI 0.75-0.95).

synapsesocial.com/papers/6a7c5f393f411608c626be9c https://doi.org/10.1016/j.ajpc.2022.100346

View Full Paper

Ask AI

Bookmark

Share

Area Deprivation Index and Oral Anticoagulation in New Onset Atrial Fibrillation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Area Deprivation Index and Oral Anticoagulation in New Onset Atrial Fibrillation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading