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), while rates did not differ by sex or socioeconomic status.
Cohort (n=9,513)
Yes
Are there racial, sex, or socioeconomic disparities in the receipt of guideline-recommended oral anticoagulation among patients with atrial fibrillation and elevated stroke risk?
In a diverse, integrated healthcare system, appropriate anticoagulation rates for atrial fibrillation were relatively high overall, but significant treatment gaps persisted for Black and Asian patients compared to White patients.
Absolute Event Rate: 70.8% vs 73.1%
p-value: p=0.03
Abstract 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 9513 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 Black and White patients (70.8% vs. 73.1%, P = .03) and Asian and White patients (68.3% vs. 71.6%, P = .005). After adjusting for CHADS 2 , this difference persisted for Black and White participants with CHADS 2 scores of ≤3 (62.6% vs. 70.6%, P 5 (68.0% vs. 79.3%, P < .001). Conclusions Black and Asian patients may have differing rates of appropriate anticoagulation when compared with White patients. Characterizing such disparities is the first step towards addressing treatment gaps in AF.
Malik et al. (2023) conducted a cohort in Atrial fibrillation with elevated thromboembolic risk (n=9,513). Black race vs. White race 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), while rates did not differ by sex or socioeconomic status.