Racial Disparity in the Prescription of Anticoagulants and Risk of Stroke and Bleeding in Atrial Fibrillation Patients

Tedla, Yacob; Schwartz, Sarah M.; Silberman, Philip; Greenland, Philip; Passman, Rod

doi:10.1016/j.jstrokecerebrovasdis.2020.104718

Cited by 26 publications

(34 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…56 A recent 2020 study, however, found that Black, Asian, and other minority ethnics were in fact, significantly less likely to receive any OACs, the difference continuing to be significant even after accounting for socioeconomic factors. 57 The efficacy and required doses of OACs have not been performed in populations with adequate representation of ethnic minorities, and therefore cannot be commented on at this time. 49,57 Several studies have also noted that non-White populations are less likely to be treated with rhythm control modalities and are instead treated with a rate control modality.…”

Section: Arrhythmiasmentioning

confidence: 99%

“…57 The efficacy and required doses of OACs have not been performed in populations with adequate representation of ethnic minorities, and therefore cannot be commented on at this time. 49,57 Several studies have also noted that non-White populations are less likely to be treated with rhythm control modalities and are instead treated with a rate control modality. Following rhythm control modalities, White patients were more likely to undergo cardioversion, be prescribed antiarrhythmic medication, and undergo interventional AF procedures, such as catheter ablation and surgery than Black and Hispanic patients.…”

Section: Arrhythmiasmentioning

confidence: 99%

“…A 2018 study comparing the rates of prescription of OACs among Black, White, and Hispanic AF patients calculated a 27% decrease in the likelihood of receiving NOACs in Black patients but deemed that figure insignificant after accounting for socioeconomic factors 56 . A recent 2020 study, however, found that Black, Asian, and other minority ethnics were in fact, significantly less likely to receive any OACs, the difference continuing to be significant even after accounting for socioeconomic factors 57 . The efficacy and required doses of OACs have not been performed in populations with adequate representation of ethnic minorities, and therefore cannot be commented on at this time 49,57 …”

Section: Disparities In Treatmentsmentioning

confidence: 99%

See 2 more Smart Citations

Racial disparities and cardiovascular disease: One size fits all approach?

et al. 2020

View full text Add to dashboard Cite

Background: Despite recent advancements in prevention, treatment, and management options, cardiovascular diseases contribute to one of the leading causes of morbidity and mortality. Several studies highlight the compelling evidence for the existence of healthcare inequities and disparities in the treatment and management control of cardiovascular diseases. Aims: To explore the role of racial disparities in the treatment of various cardiovascular diseases, highlighting the role of socioeconomic and cultural factors, and ultimately postulate solutions to eliminate the disparities. Methods: A comprehensive review of the literature was conducted using appropriate keywords on search engines of SCOPUS, Wiley, PubMed, and SAGE Journals. Conclusion: By continued research to eliminate healthcare inequalities, there exists a potential to improve health-related outcomes in minority populations.

show abstract

Section: Arrhythmiasmentioning

confidence: 99%

Section: Arrhythmiasmentioning

confidence: 99%

Section: Disparities In Treatmentsmentioning

confidence: 99%

See 1 more Smart Citation

Racial disparities and cardiovascular disease: One size fits all approach?

et al. 2020

View full text Add to dashboard Cite

show abstract

“…55 A recent 2020 study, however, found that Black, Asian, and other minority ethnics were in fact, significantly less likely to receive any OACs, the difference continuing to be significant even after accounting for socioeconomic factors. 56 The efficacy and required doses of OACs have not been performed in populations with adequate representation of ethnic minorities, and therefore cannot be commented on at this time. 53,56 Several studies have also noted that non-White populations are less likely to be treated with rhythm control modalities and are instead treated with a rate control modality.…”

Section: Arrhythmiasmentioning

confidence: 99%

“…56 The efficacy and required doses of OACs have not been performed in populations with adequate representation of ethnic minorities, and therefore cannot be commented on at this time. 53,56 Several studies have also noted that non-White populations are less likely to be treated with rhythm control modalities and are instead treated with a rate control modality. Following rhythm control modalities, White patients were more likely to undergo cardioversion, be prescribed antiarrhythmic medication, and undergo interventional AF procedures, such as catheter ablation and surgery than Black and Hispanic patients.…”

Section: Arrhythmiasmentioning

confidence: 99%

Racial Disparities and Cardiovascular Disease: One Size Fits All Approach?

Ashwitha¹,

Wee²,

Shirke³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Despite recent advancements in prevention, treatment, and management options, cardiovascular diseases contribute to one of the leading causes of morbidity and mortality. Several studies highlight the compelling evidence for the existence of healthcare inequities and disparities in the treatment and management control of cardiovascular diseases. Aims: To explore the role of racial disparities in the treatment of various cardiovascular diseases, highlighting the role of socioeconomic and cultural factors, and ultimately postulate solutions to eliminate the disparities. Methods: A comprehensive review of literature was conducted using appropriate keywords on search engines of SCOPUS, Wiley, PubMed, and SAGE Journals. Conclusion: By continued research to eliminate healthcare inequalities, there exists a potential to improve health-related outcomes in minority populations.

show abstract

Association of Race and Ethnicity With Oral Anticoagulation and Associated Outcomes in Patients With Atrial Fibrillation

et al. 2022

View full text Add to dashboard Cite

ImportanceOral anticoagulation (OAC) is underprescribed in underrepresented racial and ethnic group individuals with atrial fibrillation (AF). Little is known of how differential OAC prescribing relates to inequities in AF outcomes.ObjectiveTo compare OAC use at discharge and AF-related outcomes by race and ethnicity in the Get With The Guidelines–Atrial Fibrillation (GWTG-AFIB) registry.Design, Setting, and ParticipantsThis retrospective cohort analysis used data from the GWTG-AFIB registry, a national quality improvement initiative for hospitalized patients with AF. All registry patients hospitalized with AF from 2014 to 2020 were included in the study. Data were analyzed from November 2021 to July 2022.ExposuresSelf-reported race and ethnicity assessed in GWTG-AFIB registry.Main Outcomes and MeasuresThe primary outcome was prescription of direct-acting OAC (DOAC) or warfarin at discharge. Secondary outcomes included cumulative 1-year incidence of ischemic stroke, major bleeding, and mortality postdischarge. Outcomes adjusted for patient demographic, clinical, and socioeconomic characteristics as well as hospital factors.ResultsAmong 69 553 patients hospitalized with AF from 159 sites between 2014 and 2020, 863 (1.2%) were Asian, 5062 (7.3%) were Black, 4058 (5.8%) were Hispanic, and 59 570 (85.6%) were White. Overall, 34 113 (49.1%) were women; the median (IQR) age was 72 (63-80) years, and the median (IQR) CHA2DS2-VASc score (calculated as congestive heart failure, hypertension, age 75 years and older, diabetes, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, and sex category) was 4 (2-5). At discharge, 56 385 patients (81.1%) were prescribed OAC therapy, including 41 760 (74.1%) receiving DOAC. OAC prescription at discharge was lowest in Hispanic patients (3010 [74.2%]), followed by Black patients (3935 [77.7%]) Asian patients (691 [80.1%]), and White patients (48 749 [81.8%]). Black patients were less likely than White patients to be discharged while taking any anticoagulant (adjusted odds ratio, 0.75; 95% CI, 0.68-0.84) and DOACs (adjusted odds ratio, 0.73; 95% CI, 0.65-0.82). In 16 307 individuals with 1-year follow up data, bleeding risks (adjusted hazard ratio [aHR], 2.08; 95% CI, 1.53-2.83), stroke risks (aHR, 2.07; 95% CI, 1.34-3.20), and mortality risks (aHR, 1.22; 95% CI, 1.02-1.47) were higher in Black patients than White patients. Hispanic patients had higher stroke risk (aHR, 2.02; 95% CI, 1.38-2.95) than White patients.Conclusions and RelevanceIn a national registry of hospitalized patients with AF, compared with White patients, Black patients were less likely to be discharged while taking anticoagulant therapy and DOACs in particular. Black and Hispanic patients had higher risk of stroke compared with White patients; Black patients had a higher risk of bleeding and mortality. There is an urgent need for interventions to achieve pharmacoequity in guideline-directed AF management to improve overall outcomes.

show abstract

Racial Disparity in the Prescription of Anticoagulants and Risk of Stroke and Bleeding in Atrial Fibrillation Patients

Cited by 26 publications

References 25 publications

Racial disparities and cardiovascular disease: One size fits all approach?

Racial disparities and cardiovascular disease: One size fits all approach?

Racial Disparities and Cardiovascular Disease: One Size Fits All Approach?

Association of Race and Ethnicity With Oral Anticoagulation and Associated Outcomes in Patients With Atrial Fibrillation

Contact Info

Product

Resources

About