Racial Disparities Found in Oral Anticoagulant Prescription Patterns

Utibe R. Essien, MD, MPH

Black patients with atrial fibrillation are significantly less likely to receive oral anticoagulants than white and Hispanic patients, a study has found.

In addition, the quality of the anticoagulants prescribed was lower in black and Hispanic individuals, according to the study, published in the December 2018 issue of JAMA Cardiology.

"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," says Utibe R. Essien, MD, MPH, lead author and assistant professor in the Division of General Internal Medicine at the University of Pittsburgh, in a statement from the university.

Reasons for the racial disparities among anticoagulant use can include limited access to specialists, out-of-pocket costs, medication adherence, and implicit bias, according to the article.

“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,” Essien adds.

Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II), Essien and colleagues analyzed data for 11,100 white patients, 646 black patients, and 671 Hispanic patients with atrial fibrillation. The data was collected from February 2013 through June 2016.

There was no significant difference in the use of oral anticoagulants between white and Hispanic patients. But after controlling for clinical and sociodemographic factors, black patients had 25% lower odds of receiving any oral anticoagulant drugs, compared with white and Hispanic patients. They also had 37% lower odds of receiving any of the newer direct-acting oral anticoagulants (DOACs), which are considered to be safer choices for anticoagulation, according to the statement.

The study also found that black patients (15.5%) and Hispanic patients (18.1%) treated with DOACs were more likely to receive inappropriate dosing than were white patients (12.6%).

Among patients receiving warfarin (Coumadin), the median time in therapeutic range was lower in black patients (57.1%) and Hispanic patients (51.7%) than in white patients (67.1%).

Further research is needed to address and correct the issues, according to the study authors. “Identifying modifiable causes of these disparities could improve the quality of care in atrial fibrillation,” Essien writes in the JAMA Cardiology article.