Racial/Ethnic Disparities Seen in Anticoagulant Initiation for A-Fib

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Disparities seen among VA patients both for initiating any anticoagulant therapy and for initiating direct-acting oral anticoagulant use

HealthDay News — Race/ethnicity is independently associated with initiating any anticoagulant therapy and direct-acting oral anticoagulant use among anticoagulant initiators for Veterans Health Administration (VA) patients with incident atrial fibrillation, according to a study published online July 28 in JAMA Network Open.

Utibe R. Essien, MD, MPH, from the VA Pittsburgh Healthcare System, and colleagues compared initiation of anticoagulant therapy (warfarin or direct-acting oral anticoagulants, apixaban, dabigatran, edoxaban, or rivaroxaban) by race/ethnicity for patients in the VA system with atrial fibrillation. The analysis included 111,666 patients with incident atrial fibrillation (2014 through 2018).

The researchers found that 62.3% of patients initiated any anticoagulant therapy, varying 10.5 percentage points by race/ethnicity. Among those initiating anticoagulants, overall, 65.2% used direct-acting oral anticoagulants, with 7.2 percentage points of variance by race/ethnicity. The odds of initiating any anticoagulant therapy were significantly lower for Asian (adjusted odds ratio [aOR], 0.82) and Black (aOR, 0.90) patients compared with White patients. The adjusted odds of direct-acting oral anticoagulant initiation were significantly lower for Hispanic (aOR, 0.79), American Indian/Alaska Native (aOR, 0.75), and Black (aOR, 0.74) patients initiating anticoagulants vs White patients.

“In the Veterans Health Administration system, a national, integrated health system with improved access to medications through a uniform national drug formulary, racial and ethnic disparities appear to persist in atrial fibrillation management,” said the authors.

Abstract/Full Text