Compared with White patients, the odds of initiating any anticoagulant therapy were significantly lower for Asian (aOR 0.82; 95% CI 0.72-0.94) and Black (aOR 0.90; 95% CI 0.85-0.95) patients.
Cohort (n=111,666)
Yes
Effect estimate: aOR 0.90 (95% CI 0.85-0.95)
Absolute Event Rate: 60.3% vs 62.7%
p-value: p=<.001
Importance: Atrial fibrillation is a common cardiac rhythm disturbance causing substantial morbidity and mortality that disproportionately affects racial/ethnic minority groups. Anticoagulation reduces stroke risk in atrial fibrillation, yet studies show it is underprescribed in racial/ethnic minority patients. Objective: To compare initiation of anticoagulant therapy by race/ethnicity for patients in the Veterans Health Administration (VA) system with atrial fibrillation. Design, Setting, and Participants: This retrospective cohort study included 111 666 patients within the VA system with incident atrial fibrillation between January 1, 2014, and December 31, 2018. Data were analyzed between December 1, 2019, and March 31, 2020. Exposures: Any anticoagulation was defined as receipt of warfarin or direct-acting oral anticoagulants, apixaban, dabigatran, edoxaban, or rivaroxaban. Main Outcomes and Measures: Initiation of any anticoagulation (or direct-acting oral anticoagulant therapy in those who initiated any anticoagulation) was examined within 90 days of an index atrial fibrillation diagnosis. Results: Our final cohort comprised 111 666 patients (109 386 men 98.0% and 95 493 White patients 85.5%; mean SD age, 72.9 10.4 years). A total of 69 590 patients (62.3%) initiated any anticoagulant therapy, varying 10.5 percentage points by race/ethnicity (P < .001); initiation was lowest in Asian (52.2% n = 676) and Black (60.3% n = 6177) patients and highest in White patients (62.7% n = 59 881). Among anticoagulant initiators, 45 381 (65.2%) used direct-acting oral anticoagulants, varying 7.2 percentage points by race/ethnicity (P < .001); initiation was lowest in Hispanic (58.3% n = 1470), American Indian/Alaska Native (59.8% n = 201), and Black (60.9% n = 3763) patients and highest in White patients (66.0% n = 39 502). Compared with White patients, the odds of initiating any anticoagulant therapy were significantly lower for Asian (adjusted odds ratio [aOR, 0.82; 95% CI, 0.72-0.94) and Black (aOR, 0.90; 95% CI 0.85-0.95) patients. Among initiators, the adjusted odds of direct-acting oral anticoagulant initiation were significantly lower for Hispanic (aOR, 0.79; 95% CI, 0.70-0.89), American Indian/Alaska Native (aOR, 0.75; 95% CI, 0.57-0.99), and Black (aOR, 0.74; 95% CI 0.69-0.80) patients. Conclusions and Relevance: This cohort study found that in patients with incident atrial fibrillation managed in the VA system, race/ethnicity was independently associated with initiating any anticoagulant therapy and direct-acting oral anticoagulant use among anticoagulant initiators. Understanding the reasons for these treatment disparities is essential to improving equitable atrial fibrillation management and outcomes among racial/ethnic minority patients treated in the VA system.
Essien et al. (Wed,) conducted a cohort in Incident atrial fibrillation (n=111,666). Racial/ethnic minority status vs. White patients was evaluated on Initiation of any anticoagulation within 90 days of an index atrial fibrillation diagnosis (aOR 0.90, 95% CI 0.85-0.95, p=<.001). Compared with White patients, the odds of initiating any anticoagulant therapy were significantly lower for Asian (aOR 0.82; 95% CI 0.72-0.94) and Black (aOR 0.90; 95% CI 0.85-0.95) patients.