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Direct oral anticoagulants given less often to black patients with VTE
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Incident venous thromboembolism was less likely to be treated with direct oral anticoagulants in black patients and those with low household income despite an increase in its use since 2012, according to data presented at the American Heart Association Quality of Care and Outcomes Research Scientific Sessions.
This study was also simultaneously published in Circulation: Cardiovascular Quality and Outcomes.
“We as treating providers need to be cognizant about inequities that may exist within medicine and do what we can do mitigate them,” Ashwin S. Nathan, MD, fellow in the division of cardiovascular medicine at the Hospital of the University of Pennsylvania Perelman School of Medicine, told Cardiology Today. “This study emphasizes the importance of efforts to ensure the equitable treatment of all racial, ethnic and socioeconomic groups.”
Researchers analyzed data from 14,140 patients (mean age, 59 years; 79% white; 14% black) from the OptumInsight Clinformatics Data Mart database with an index diagnosis of VTE between 2010 and 2016 and who filled a prescription for an oral anticoagulant within 30 days after hospital discharge. Information from the database included outpatient, inpatient, laboratory and pharmacy claims, in addition to socioeconomic data and information on race/ethnicity.
The percentage of patients who were treated with direct oral anticoagulants increased from less than 0.1% in 2010 to 65.6% in 2016.
Black patients were less likely to be treated with direct oral anticoagulants compared with white patients in multivariable analyses (OR = 0.86; 95% CI, 0.77-0.97). These differences were not seen among Hispanic patients (OR = 1.04; 95% CI, 0.88-1.22) or Asian patients (OR = 1.06; 95% CI, 0.75-1.49) compared with white patients.
Direct oral anticoagulants were more likely to be given to patients with a household income more than $100,000 per year vs. those with an income less than $40,000 per year (OR = 1.5; 95% CI, 1.33-1.69).
“From a clinical perspective, the finding about socioeconomic status may be a rational physician response to the reality of real-world U.S. clinical practice,” Jay Giri, MD, MPH, director of peripheral intervention and assistant professor of medicine at the Hospital of the University of Pennsylvania and a Cardiology Today Next Gen Innovator, said in an interview. “As physicians taking care of patients with VTE, we know it is of paramount importance that anticoagulation is adhered to after an incident diagnosis. And it’s reasonable to assume that the [direct oral anticoagulants], over the time period studied, may have been associated with higher out-of-pocket costs even in this fully insured population of patients. A doctor’s decision to go with the older, cheaper and less convenient warfarin may well have been rational in this group.” – by Darlene Dobkowski
References:
Nathan AS. QCOR 2019 Early Career Investigator Award Finalists. Presented at: American Heart Association Quality of Care and Outcomes Research Scientific Sessions; April 5-6, 2019; Arlington, Va.
Nathan AS, et al. Circ Cardiovasc Qual Outcomes. 2019;doi:10.1161/CIRCOUTCOMES.119.005600.
Disclosures: The authors report no relevant financial disclosures.