New study finds racial disparities in oral anticoagulant use

November 28, 2018

PITTSBURGH, Nov. 28, 2018 - Black patients with atrial fibrillation are significantly less likely to receive oral anticoagulants--particularly newer, more effective versions--than white and Hispanic patients, according to a new study published today in JAMA Cardiology.

First author Utibe R. Essien, M.D., M.P.H., assistant professor in the University of Pittsburgh Division of General Internal Medicine, used the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II registry (ORBIT-AF II) to source patient data for the study. He conducted the research during his fellowship at Massachusetts General Hospital.

Registry data for 11,100 white patients, 646 black patients and 671 Hispanic patients with atrial fibrillation collected from February 2013 through June 2016 was included in the analysis. After controlling for clinical and sociodemographic factors, black patients had 25 percent lower odds of receiving any oral anticoagulant drugs compared to their white and Hispanic counterparts, and 37 percent lower odds of receiving the easier to use and likely safer direct-acting oral anticoagulants. There was no difference in prescriptions between whites and Hispanics.

"For patients with atrial fibrillation, long-term oral anticoagulant use can reduce their risk of stroke. Even after our analysis adjusted for socioeconomic factors, black patients were still less likely to receive these types of drugs," said Essien. "Blacks with atrial fibrillation are already at a higher risk of complications, so improving health literacy and reducing disparities related to medication use could help improve their overall quality of care and reduce complications."

Many factors, including limited access to specialists, out-of-pocket costs, medication adherence and implicit bias, have been suggested as possible reasons for the disparities in care for patients with atrial fibrillation, but further research is needed to address and correct these issues.
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Additional authors include senior author Daniel E. Singer, M.D., of Massachusetts General Hospital, as well as others from institutions across the country. Essien was supported by National Research Service Award Grant T32-HP10251, and Singer was supported in part by the Eliot B. and Edith C. Shoolman Fund of Massachusetts General Hospital.

The ORBIT-AF II registry is sponsored by Janssen Scientific Affairs LLC, and the sponsor was not involved in any aspects of the study or the decision to submit the manuscript for publication.

About the University of Pittsburgh Schools of the Health Sciences

The University of Pittsburgh Schools of the Health Sciences include the schools of Medicine, Nursing, Dental Medicine, Pharmacy, Health and Rehabilitation Sciences and the Graduate School of Public Health. The schools serve as the academic partner to the UPMC (University of Pittsburgh Medical Center). Together, their combined mission is to train tomorrow's health care specialists and biomedical scientists, engage in groundbreaking research that will advance understanding of the causes and treatments of disease and participate in the delivery of outstanding patient care. Since 1998, Pitt and its affiliated university faculty have ranked among the top 10 educational institutions in grant support from the National Institutes of Health. For additional information about the Schools of the Health Sciences, please visit http://www.health.pitt.edu.

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