Patients of color with atrial fibrillation (AF) are less likely to receive oral anticoagulation (OAC). However, how uneven OAC prescribing contributes to disparities in AF outcomes is little known. The purpose of this analysis was to examine the relationship between OAC use at discharge and AF-related outcomes in the Get With The Guidelines-Atrial Fibrillation (GWTG-AFIB) registry by race and ethnicity. Information from the national quality improvement project for hospitalized AF patients, the GWTG-AFIB registry, was used for this retrospective cohort study. Patients hospitalized with AF in the registry between 2014 and 2020 were included. All of the information gathered between November 2021 and July 2022 was evaluated.
The primary outcome was the prescription of a direct-acting OAC (DOAC) or warfarin upon discharge. Major bleeding, post-discharge death, and the cumulative incidence of ischemic stroke after 1 year were included as secondary outcomes after considering patients’ demographic, clinical, socioeconomic, and hospital-specific aspects. From 2014 to 2020, 59,570 (85.6%) of the 69,553 patients hospitalized with AF were white, 5,062 (7.3%) were black, 4,058 (5.7%) were Hispanic, and 863 (1.2%) were Asian. The median (interquartile range) age was 72 (63-80) years, and the median (interquartile range) CHA2DS2-VASc score (congestive heart failure, hypertension, age 75+, diabetes, stroke/TIA/transient ischemic attack, vascular disease, age 65-74, and sex category) was 4 (2-5). At discharge, 56 385 patients (81.1%) were prescribed OAC therapy, including 41,760 (74.1%) receiving DOAC. Patients of Hispanic origin (30,010; 74.2%) had the lowest rate of OAC prescription at discharge, followed by patients of African American origin (3,935; 77.7%), Asian origin (691; 80.1%), and White origin (48,749; 81.9%). Discharge rates for black patients on any anticoagulant (adjusted odds ratio, 0.75; 95% CI, 0.68-0.84) and DOACs (adjusted odds ratio, 0.73; 95% CI, 0.65-0.82) were lower than those for white patients.
Risks of bleeding (adjusted hazard ratio [aHR] 2.08; 95% CI, 1.53-2.83), stroke (aHR 2.07; 95% CI, 1.34-3.20), and mortality (aHR 1.22; 95% CI, 1.02-1.47) were all greater in black patients than white patients in a study of 16,307 people with data on the first year of follow-up. The risk of stroke was higher among Hispanic patients than white patients (adjusted HR, 2.02; 95% CI, 1.38-2.95). Anticoagulant medication, and direct oral anticoagulants, in particular, were associated with a lower discharge rate for black patients in a nationwide registry of hospitalized patients with AF compared to white patients. Patients of color (Blacks and Hispanics) were shown to be at a higher risk of stroke than Whites, while Black patients were found to be at a higher risk of hemorrhage and mortality. To enhance overall outcomes, pharmacoequity in guideline-directed AF therapy is urgently needed.