Association of Neighborhood Disadvantage and Anticoagulation for Patients with Atrial Fibrillation in the Veterans Health Administration: the REACH-AF Study

McDermott, Annie; Kim, Nadejda; Hausmann, Leslie R. M.; Magnani, Jared W.; Good, Chester B.; Litam, Terrence M A; Mor, Maria K.; Omole, Toluwa; Gellad, Walid F.; Fine, Michael J.; Essien, Utibe R.

doi:10.1007/s11606-022-07810-z

Cited by 4 publications

(8 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Whereas the main effects of the association between Black race (aOR, 0.82; 95% CI, 0.78-0.87) and Hispanic ethnicity (aOR, 0.91; 95% CI, 0.83-0.99) and any anticoagulant initiation were statistically significant, there was no significant race and ethnicity by medical center racial and ethnic composition interaction in our model (χ 2 6 = 1.46; P = . 19), indicating similar Black-White and Hispanic-White differences in prescribing across all 4 quartiles.…”

Section: Initiation Of Any Anticoagulant Therapy By Va Medical Center...mentioning

confidence: 87%

“…We conducted a retrospective cohort study in the previously described Race, Ethnicity and Anticoagulant Choice in Atrial Fibrillation (REACH-AF) cohort. 10 , 19 This analysis included patients with incident nonvalvular AF treated at all VA medical centers (VAMCs) nationwide (140 centers) and their associated community-based outpatient clinics from 2018 to 2021. The institutional review board at the VA Pittsburgh Healthcare System approved the study and granted a waiver of informted consent as data in the cohort were deidentified.…”

Section: Methodsmentioning

confidence: 99%

“… 24 Both geographic region and ADI were included in our analysis given prior work demonstrating their association with anticoagulant prescribing. 19 , 25 Baseline patient clinical characteristics consisted of select cardiometabolic medical comorbidities (eg, hypertension, diabetes, vascular disease, and congestive heart failure). 10 , 22 We quantified 1-year stroke risk in AF using the validated CHA 2 DS 2 VASc score (low, 0-1; moderate, 2-4; and high, >4), which includes congestive heart failure, hypertension, being aged more than 75 years, diabetes, prior stroke, transient ischemic attack, or thromboembolism, vascular disease, being aged 65 to 74 years, and female sex.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Veterans Affairs Medical Center Racial and Ethnic Composition and Initiation of Anticoagulation for Atrial Fibrillation

Essien,

Kim,

Hausmann

et al. 2024

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

ImportanceRacial and ethnic disparities exist in anticoagulation therapy for atrial fibrillation (AF). Whether medical center racial and ethnic composition is associated with these disparities is unclear.ObjectiveTo determine whether medical center racial and ethnic composition is associated with overall anticoagulation and disparities in anticoagulation for AF.Design, Setting, and ParticipantsRetrospective cohort study of Black, White, and Hispanic patients with incident AF from 2018 to 2021 at 140 Veterans Health Administration medical centers (VAMCs). Data were analyzed from March to November 2023.ExposureVAMC racial and ethnic composition, defined as the proportion of patients from minoritized racial and ethnic groups treated at a VAMC, categorized into quartiles. VAMCs in quartile 1 (Q1) had the lowest percentage of patients from minoritized groups (ie, the reference group).Main Outcomes and MeasuresThe odds of initiating any anticoagulant, direct-acting oral anticoagulant (DOAC), or warfarin therapy within 90 days of an index AF diagnosis, adjusting for sociodemographics, medical comorbidities, and facility factors.ResultsThe cohort comprised 89 791 patients with a mean (SD) age of 73.0 (10.1) years; 87 647 (97.6%) were male, 9063 (10.1%) were Black, 3355 (3.7%) were Hispanic, and 77 373 (86.2%) were White. Overall, 64 770 individuals (72.1%) initiated any anticoagulant, 60 362 (67.2%) initiated DOAC therapy, and 4408 (4.9%) initiated warfarin. Compared with White patients, Black and Hispanic patients had lower rates of any anticoagulant and DOAC therapy initiation but higher rates of warfarin initiation across all quartiles of VAMC racial and ethnic composition. Any anticoagulant therapy initiation was lower in Q4 than Q1 (69.8% vs 74.9%; adjusted odds ratio [aOR], 0.80; 95% CI, 0.69-0.92; P &lt; .001). DOAC and warfarin initiation were also lower in Q4 than in Q1 (DOAC, 69.4% vs 65.3%; aOR, 0.85; 95% CI, 0.74-0.97; P &lt; .001; warfarin, 5.4% vs 4.5%; aOR, 0.82; 95% CI, 0.67-1.00; P &lt; .001). In adjusted models, patients in Q4 were significantly less likely to initiate any anticoagulant therapy than those in Q1 (aOR, 0.88; 95% CI, 0.78-0.99). Patients in Q3 (aOR, 0.75; 95% CI, 0.60-0.93) and Q4 (aOR, 0.69; 95% CI, 0.55-0.87) were significantly less likely to initiate warfarin therapy than those in Q1. There was no significant difference in the adjusted odds of initiating DOAC therapy across racial and ethnic composition quartiles. Although significant Black-White and Hispanic-White differences in initiation of any anticoagulant, DOAC, and warfarin therapy were observed, interactions between patient race and ethnicity and VAMC racial composition were not significant.Conclusions and RelevanceIn a national cohort of VA patients with AF, initiation of any anticoagulant and warfarin, but not DOAC therapy, was lower in VAMCs serving more minoritized patients.

show abstract

Section: Initiation Of Any Anticoagulant Therapy By Va Medical Center...mentioning

confidence: 87%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Veterans Affairs Medical Center Racial and Ethnic Composition and Initiation of Anticoagulation for Atrial Fibrillation

Essien,

Kim,

Hausmann

et al. 2024

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…6 While evaluations of the built environment via the neighborhood deprivation index have not demonstrated a difference in overall OAC prescriptions, a higher deprivation index is associated with a lower likelihood of DOAC prescription. 7 Additionally, patient insurance has been identified as a predictive factor of VKA versus DOAC prescription. 8 In terms of patient factors associated OAC prescriptions, it is well-established that increasing age and increasing HAS-BLED scores are associated with fewer OAC prescriptions.…”

Section: Atrial Fibrillation (Af) Is the Most Common Dysrhythmia In T...mentioning

confidence: 99%

“…A study in the Veterans Affairs population determined that the odds of receiving an appropriate OAC prescription was lower in both Asian and Black populations compared to Whites and the odds of receiving a DOAC compared to a VKA was likewise lower among minorities 6 . While evaluations of the built environment via the neighborhood deprivation index have not demonstrated a difference in overall OAC prescriptions, a higher deprivation index is associated with a lower likelihood of DOAC prescription 7 . Additionally, patient insurance has been identified as a predictive factor of VKA versus DOAC prescription 8 …”

Section: Introductionmentioning

confidence: 99%

Factors associated with oral anticoagulant prescription status among patients with a new diagnosis of atrial fibrillation

Manning

Burns

Laurie

et al. 2023

Clinical Cardiology

View full text Add to dashboard Cite

BackgroundAtrial fibrillation (AF) is the most common sustained arrhythmia in adults and increases stroke risk. Treatment with oral anticoagulants (OACs) may reduce this risk however many patients do not receive OAC therapy. This study aimed to use electronic health record data to identify newly diagnosed AF patients at high risk for stroke and not anticoagulated as well as factors associated with OAC prescription.HypothesisTimely prescription of OACs among patients with newly diagnosed AF is poor.MethodsWe performed a retrospective study of patients with a new diagnosis of AF. We assessed stroke risk with the CHA2DS2‐VASc score. The primary outcome was prescription of an OAC within 6 months following diagnosis. We used logistic regression to see how the odds of being prescribed an OAC differs for 17 independent variables.ResultsWe identified 18 404 patients with a new diagnosis of AF. Among patients at high risk for stroke, 41.3% received an OAC prescription within 6 months. Male sex, Caucasian compared to African American race, stroke, obesity, congestive heart failure, vascular disorder, current antiplatelet, beta blocker, or calcium channel blocker prescription, and increasing CHA2DS2‐VASc score were positively associated with receiving an OAC. Whereas anemia, renal dysfunction, liver dysfunction, antiarrhythmic drug use and increasing HAS‐BLED score were negatively associated.ConclusionsMost newly diagnosed AF patients at high stroke risk do not receive an OAC prescription in the first 6 months following diagnosis. Our analysis suggests that patient sex, race, comorbidities, and additional prescriptions are associated with rates of OAC prescribing.

show abstract

Eliminating Health Disparities in Atrial Fibrillation, Heart Failure, and Dyslipidemia: A Path Toward Achieving Pharmacoequity

Amin,

Bethel,

Jackson

et al. 2023

Curr Atheroscler Rep

View full text Add to dashboard Cite

Association of Neighborhood Disadvantage and Anticoagulation for Patients with Atrial Fibrillation in the Veterans Health Administration: the REACH-AF Study

Cited by 4 publications

References 49 publications

Veterans Affairs Medical Center Racial and Ethnic Composition and Initiation of Anticoagulation for Atrial Fibrillation

Veterans Affairs Medical Center Racial and Ethnic Composition and Initiation of Anticoagulation for Atrial Fibrillation

Factors associated with oral anticoagulant prescription status among patients with a new diagnosis of atrial fibrillation

Eliminating Health Disparities in Atrial Fibrillation, Heart Failure, and Dyslipidemia: A Path Toward Achieving Pharmacoequity

Contact Info

Product

Resources

About