Arrhythmias and Conduction DisturbancesRacial Differences in Quality of Anticoagulation Therapy for Atrial Fibrillation (from the TREAT-AF Study)
Section snippets
Methods
The Retrospective Evaluation and Assessment of Therapies in AF cohort is a retrospective cohort of patients with newly diagnosed AF from the Veterans Administration (VHA) health care system.5 The VHA is the largest integrated health system in the United States. We used the following centralized, comprehensive VHA data sets of care: (1) the VHA National Patient Care Database, (2) the VHA Managerial Cost Accounting national pharmacy data set, (3) the VHA Fee Basis inpatient and outpatient data
Results
Of 523,675 patients identified with AF in FY04-FY12, 184,161 had newly diagnosed AF and met inclusion criteria (Figure 2). Analysis of baseline characteristics (Table 1) demonstrated that black patients had higher CHADS2 risk scores, ATRIA bleeding risk scores, Charlson, and Selim co-morbidity scores compared to all other races (p <0.0001). In particular, congestive heart failure, hypertension, and diabetes were significantly higher among blacks (p <0.0001).
In this cohort, 62.2% of patients
Discussion
The principal finding of this study is that despite similar INR monitoring intensity among warfarin-treated patients with AF, anticoagulation control was substantially lower in blacks than for all other racial groups and was highest in whites, even after accounting for clinical, sociodemographic, and site-level factors. Moreover, blacks lived closer to medical care than other racial groups and had greater utilization of cardiology care after new diagnosis of AF.
There are several potential
Disclosures
Dr. Turakhia is supported by a Veterans Health Services Research and Development Career Development Award (CDA09027-1), an American Heart Association National Scientist Development Grant (09SDG2250647), and a VHA Health Services and Development MERIT Award (IIR 09-092). Dr. Yong was supported by an ACCF/Merck Cardiovascular Research Fellowship. The other authors have no conflicts of interest to disclose.
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Cited by (29)
Racial and Ethnic Disparities in Stroke Prevention for Atrial Fibrillation
2023, American Journal of MedicineCitation Excerpt :The reasons behind this are multifactorial, but pharmacogenetics likely play a substantial role. At least six variants of CYP2C9 – an enzyme responsible for breaking down many exogenous substances – have been described (47). These variants, and others, differ between White, Black and Asian individuals (47,48).
Racial disparities among Asian Americans with atrial fibrillation: An analysis from the NCDR® PINNACLE Registry
2021, International Journal of CardiologyCitation Excerpt :We demonstrated that although Asian Americans with AF were 7% less likely to receive warfarin therapy as compared to Whites, the overall odds of being on OAC and DOAC were similar across both racial groups. Current evidence demonstrates that racial minorities such as African Americans are prone to have a lower time in therapeutic range for warfarin and higher incidence of intracranial hemorrhage (ICH) as compared to White patients [38,39]. These previously established observations may influence individual clinician practices.
Anticoagulation control in different ethnic groups receiving vitamin K antagonist therapy for stroke prevention in atrial fibrillation
2020, Thrombosis ResearchCitation Excerpt :To our knowledge, this is the first study presenting data examining anticoagulation control and adverse clinical outcomes among AF patients receiving VKA therapy for stroke prevention from the three main ethnic groups in the United Kingdom. Previous studies by Yong [18] and Golwala et al. [19] in the United States have reported that Black patients had poorer anticoagulation control compared to Whites, Hispanics, Native Americans and other ethnic minority groups, however no studies to date are available examining anticoagulation control among South-Asian patients. Several factors may contribute to this observed difference, one of which may be demographic and clinical factors among patients taking a VKA.
Racial and ethnic differences in the prevalence, management, and outcomes in patients with atrial fibrillation: A systematic review
2018, Heart RhythmCitation Excerpt :NHB participants in the ORBIT-AF had a lower median TTR, 59% compared with 68% in NHWs (P < .001).25 Similarly, in the Retrospective Evaluation and Assessment of Therapies in AF study, black race was associated with a 2.9% decrease in TTR compared to NHWs after adjusting for medication compliance and monitoring frequency.38 UREGs are at risk for poorer outcomes secondary to lower quality anticoagulation control and a higher risk of recurrent stroke and thrombosis as compared with NHWs.38,39
The content and opinions expressed are solely the responsibility of the authors and do not necessarily represent the views or policies of the Department of Veterans Affairs.
Support for VA/CMS data is provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, and VA Information Resource Center, Palo Alto, CA (Project Numbers SDR 02-237 and 98-004). It is also supported by the IIR 04-248 grant from Veterans Affairs (VA/CMS Project ID: Frayne-01).
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