Essien UR, et al. – In this study, researchers assessed the racial/ethnic differences in the use of oral anticoagulants, especially direct-acting oral anticoagulants (DOACs), among patients with atrial fibrillation. After analyzing clinical and socioeconomic factors, they found that individuals of the black community were less likely to receive DOACs for atrial fibrillation vs white individuals, with no difference between white and Hispanic groups. The quality of the use of anticoagulants in black and Hispanic individuals was lower when treating atrial fibrillation. Findings suggested that, in atrial fibrillation, the identification of modifiable causes of these disparities could improve the quality of care.

Methods

• This cohort study used data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II, a prospective, US-based registry of outpatients with non-transient atrial fibrillation 21 years and older who were followed from February 2013 to July 2016.
• From February 2017 to February 2018, data were analyzed.
• Exposures included self-reported race/ethnicity as white, black, or Hispanic.
• Use of any oral anticoagulant, especially DOACs was the primary outcome.
• The quality of anticoagulation received and oral anticoagulant discontinuation at 1 year were included secondary outcomes.

Results

• Of the 12,417 participants, 11,100 were white (88.6%), 646 were black (5.2%), and 671 were Hispanic (5.4%) with atrial fibrillation.
• Black individuals were less likely to receive any oral anticoagulant than white individuals and less likely to receive DOACs if an anticoagulant was prescribed after adjusting for clinical features.
• Oral anticoagulant use was no longer significantly different in black individuals after further controlling for socioeconomic factors.
• DOAC use remained significantly lower in black individuals among patients using oral anticoagulants.
• No significant difference was found between Hispanic and white groups in use of oral anticoagulants.
• Among those who received warfarin, median time in therapeutic range was lower in black individuals (57.1% [IQR, 39.9% to 72.5%]) and Hispanic individuals (51.7% [IQR, 39.1% to 66.7%]) vs white individuals (67.1% [IQR, 51.8% to 80.6%]; P < 0.001).
• Black and Hispanic patients treated with DOACs were more likely to receive inadequate doses than white patients (black patients, 61 of 394 [15.5%]; Hispanic patients, 74 of 409 [18.1%]; white patients, 1,003 of 7,988 [12.6%]; P=0.01).
• Oral anticoagulant use persisting for 1 year was the same across groups.