In hospitalized patients with AF, discharge on anticoagulation varies by race
Among patients hospitalized with atrial fibrillation, Black patients were less likely to be discharged while taking anticoagulant therapy, and direct oral anticoagulants in particular, than white patients, researchers reported.
Compared with white patients, Black and Hispanic patients were at greater risk for stroke and Black patients were at greater risk for bleeding and mortality, the researchers wrote.
“Oral anticoagulation is underprescribed in underrepresented racial and ethnic group individuals with atrial fibrillation. Little is known of how differential oral anticoagulant prescribing relates to inequities in AF outcomes,” Utibe R. Essien, MD, MPH, assistant professor of medicine at the University of Pittsburgh School of Medicine and core investigator at the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, and colleagues wrote.
The study included 69,553 patients hospitalized with AF at 159 sites between 2014 and 2020. Of patients included, 1.2% were Asian, 7.3% were Black, 5.8% were Hispanic and 85.6% were white.
The primary outcome was prescription of direct oral anticoagulants or warfarin at discharge. Secondary outcomes included major bleeding, mortality after discharge and ischemic stroke at 1 year.
Of the 16,307 patients with 1-year follow-up data, risk for stroke (adjusted HR = 2.07; 95% CI, 1.34-3.2), bleeding (aHR = 2.08; 95% CI, 1.53-2.83) and mortality (aHR = 1.22; 95% CI, 1.02-1.47) was higher in Black patients than white patients.
Compared with white patients, Hispanic patients had higher risk for stroke (aHR = 2.02; 95% CI, 1.38-2.95).
Oral anticoagulation prescription at hospital discharge was lowest in Hispanic patients (74.2%). The rate was 77.7% in Black patients, 80.1% in Asian patients and 81.8% in white patients.
Compared with white patients, Black patients were significantly less likely to be discharged on any oral anticoagulant (aOR = 0.75; 95% CI, 0.68-0.84) and on a direct oral anticoagulant (aOR = 0.73; 95% CI, 0.65-0.82), the researchers wrote. There were no differences between other racial/ethnic groups in adjusted models.
“The mechanisms by which racial and ethnic inequities in anticoagulation exist may include overattributing risk to patients from underrepresented racial and ethnic groups with adverse clinical and socioeconomic factors, including the presence of end-stage kidney disease, low-income level, rurality or distance to care, limited AF awareness and poor insurance access,” Essien and colleagues wrote.
Collapse