Racial and sex differences in optimizing anticoagulation therapy for patients with atrial fibrillation

Area of Science:

• Cardiology
• Health Services Research
• Health Equity

Background:

• Atrial fibrillation (AF) is a prevalent cardiac arrhythmia linked to a significant stroke burden.
• Existing research indicates disparities in anticoagulation use among minority populations and women with AF.
• Optimal anticoagulation is crucial for stroke prevention in AF patients.

Purpose of the Study:

• To compare the rates of non-optimal anticoagulation therapy among patients with atrial fibrillation, stratified by race and sex.
• To identify potential disparities in anticoagulation management using the Atrial Fibrillation Decision Support Tool (AFDST).

Main Methods:

• A retrospective cohort study was conducted involving 14,942 patients within the University of Cincinnati Health Care system.
• Data analysis spanned from November 18, 2020, to November 20, 2021.
• Non-optimal anticoagulation was defined as discordance between current therapy and AFDST recommendations.

Main Results:

• Overall, 41% of AF patients received non-optimal anticoagulation therapy.
• Non-optimal therapy rates were highest in Black patients (42%) and women (42%).
• Black patients and women showed significantly higher odds of receiving non-optimal anticoagulation compared to White patients and men, respectively.

Conclusions:

• Black race and female sex are independently associated with increased odds of receiving non-optimal anticoagulant therapy in AF patients.
• These findings underscore critical disparities in anticoagulation management for vulnerable populations.
• Addressing these disparities is essential for improving stroke prevention and outcomes in atrial fibrillation.