Gaps in Guideline-Recommended Anticoagulation in Patients with Atrial Fibrillation and Elevated Thromboembolic Risk Within an Integrated Healthcare Delivery System

Abstract

Abstract Background: Atrial Fibrillation (AF) is the leading cause of stroke, which can be reduced by 70% with appropriate oral anticoagulation (OAC) therapy. Nationally, appropriate anticoagulation rates for patients with AF with elevated thromboembolic risk are as low as 50% even across the highest stroke risk cohorts. This study aims to evaluate the variability of appropriate anticoagulation rates among patients by sex, ethnicity, and socioeconomic status within the Kaiser Permanente Mid-Atlantic States (KPMAS). Methods: This retrospective study investigated 9,513 patients in KPMAS’s AF registry with CHADS2 score ≥2 over a 6-month period in 2021. Results: Appropriately anticoagulated patients had higher rates of diabetes, prior stroke, and congestive heart failure than patients who were not appropriately anticoagulated. There were no significant differences in anticoagulation rates between males and females (71.8% vs. 71.6%%, [OR] 1.01; 95% CI, 0.93-1.11; P=.76) nor by SES-SVI quartiles. There was a statistically significant difference between Blacks and Whites (70.8% vs. 73.1%, P=.03) and Asians and Whites (68.3% vs. 71.6%, P = .005). After adjusting for CHADS2, this difference persisted for blacks and whites with CHADS2 scores of ≤3 (62.6% vs. 70.6%, P <.001) and for Asians and whites with CHADS2 scores >5 (68.0% vs. 79.3%, P<.001). Conclusions: Black and Asians may have differing rates of appropriate anticoagulation when compared with Whites. Characterizing such disparities is the first step towards addressing treatment gaps in AF.