Black Patients with AFib 25% Less Likely to Receive Oral Anticoagulant Therapy at Discharge

Utibe R. Essien, MD, MPH

New research presented at Heart Rhythm Society (HRS) 2022 is providing insight into contemporary trends in disparities of prescribing practices for anticoagulation therapy among patients with atrial fibrillation (AF).

An analysis of data from the Get With The Guidelines Atrial Fibrillation Registry, results of the study suggest Black patients were 25% less likely than their white counterparts to receive any anticoagulant at discharge and, at 1-year, Black patients were more likely to experience AF-related events, including stroke, bleeding, and mortality, than their white counterparts.

“Our findings show that racial disparities exist in ongoing, follow-up care for atrial fibrillation, which are in-turn, negatively impacting patient outcomes. Now, we must get to the root of the issue and understand what factors are driving these differences,” said lead author, Utibe R. Essien, MD, MPH, University of Pittsburgh School of Medicine, in a press release. “Every patient, regardless of race or ethnicity, deserves the chance to have life-saving treatment and we must work together to deliver equitable, compassionate care.”

A standard of care for patients with AF to prevent thromboembolic events, optimal prescription of oral anticoagulation therapy can have a major impact on individual and population level health. Despite implementation efforts, known disparities have hampered optimal prescription of oral anticoagulation therapy and newer direct oral anticoagulants. Essien and colleagues at the University of Pittsburgh School of Medicine designed the current study with the intent of assessing contemporary trends in oral anticoagulant prescription at discharge among hospitalized patients with AF in the US according to their racial/ethnic background.

With this in mind, investigators conducted an analysis of the American Heart Association’s Get With the Guidelines-AFib registry, which is a national quality improvement initiative capturing data related to hospitalized AF patients in the US. Using 2014-2020 as a period of interest, investigators identified 69,553 patients hospitalized with AF from 159 medical centers. Of these 69,553 patients, 7.3% were Black, 5.8% were Hispanic, 1.2% were Asian, and 85.6% were White patients. The mean age if the cohort was 68.6 years, the mean CHADS2VA2Sc score was 3.8, and 78.5% were discharged on an oral anticoagulant.

The primary outcome of interest for the investigator analysis was the presence of oral anticoagulation at discharge according to race/ethnicity. Secondary outcomes of interest included incidence of ischemic stroke, bleeding, or all-cause mortality at 1-year according to race/ethnicity, which was obtained using Medicare linkage data. Investigators used multivariable adjusted logistic regression analysis with GEE to assess odds of the primary outcome.

Upon analysis, results indicated black patients were 25% less likely to receive oral anticoagulation at discharge than their White counterparts (aOR, 0.75 [95% CI, 0.67-0.84]) and 18% less likely to receive direct oral anticoagulants instead of warfarin compared to their White counterparts (aOR, 0.82 [95% CI, 0.65-0.96]). Analysis of secondary outcomes suggested Black patients had higher rates of bleeding (aOR 2.08 [95% CI, 1.5-2.8]), stroke (aOR 2.07 [95% CI, 1.34-3.20]), and mortality (aOR, 1.22 [95% CI, 1.02-1.47]). Investigators pointed out results of the secondary outcomes suggested Hispanic patients also had higher stroke rates at 1-year than their White counterparts (aOR, 2.02 [95% CI, 1.38-2.95]).

This study, “Racial And Ethnic Inequities In Oral Anticoagulation And Associated Outcomes For Patients With Atrial Fibrillation - The Get With The Guidelines Atrial Fibrillation Registry,” was presented at HRS 2022.