Racial and sex differences in optimizing anticoagulation therapy for patients with atrial fibrillation.

Autor:	Eckman MH; Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America., Wise R; Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America., Leonard AC; Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, United States of America., Baker P; Center for Health Informatics, University of Cincinnati College of Medicine, United States of America., Ireton R; Center for Health Informatics, University of Cincinnati College of Medicine, United States of America., Harnett BM; Center for Health Informatics, University of Cincinnati College of Medicine, United States of America., Dixon E; Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America., Awosika B; Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America., Ezigbo C; Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America., Flaherty ML; Department of Neurology, University of Cincinnati College of Medicine, United States of America., Adejare A; Department of Biomedical Informatics, University of Cincinnati College of Medicine, United States of America., Knochelmann C; Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, United States of America., Mardis R; Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, United States of America., Wright S; University of Cincinnati Health System, United States of America., Gummadi A; Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America., Becker R; Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, United States of America., Schauer DP; Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America., Costea A; Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, United States of America., Kleindorfer D; Department of Neurology, University of Michigan College of Medicine, United States of America., Sucharew H; Cincinnati Children's Hospital Medical Center, United States of America., Costanzo A; University of Cincinnati College of Nursing, United States of America., Anderson L; University of Cincinnati, United States of America., Kues J; Department of Family and Community Medicine, University of Cincinnati College of Medicine, United States of America.
Jazyk:	angličtina
Zdroj:	American heart journal plus : cardiology research and practice [Am Heart J Plus] 2022 Jul 02; Vol. 18, pp. 100170. Date of Electronic Publication: 2022 Jul 02 (Print Publication: 2022).
DOI:	10.1016/j.ahjo.2022.100170
Abstrakt:	Study Objective: Atrial fibrillation (AF) is the most common cardiac rhythm disorder, responsible for 15 % of strokes in the United States. Studies continue to document underuse of anticoagulation therapy in minority populations and women. Our objective was to compare the proportion of AF patients by race and sex who were receiving non-optimal anticoagulation as determined by an Atrial Fibrillation Decision Support Tool (AFDST). Design Setting and Participants: Retrospective cohort study including 14,942 patients within University of Cincinnati Health Care system. Data were analyzed between November 18, 2020, and November 20, 2021. Main Outcomes and Measures: Discordance between current therapy and that recommended by the AFDST. Results: In our two-category analysis 6107 (41 %) received non-optimal anticoagulation therapy, defined as current treatment category ≠ AFDST-recommended treatment category. Non-optimal therapy was highest in Black (42 % [ n  = 712]) and women (42 % [ n  = 2668]) and lower in White (39 % [ n  = 4748]) and male (40 % [ n  = 3439]) patients. Compared with White patients, unadjusted and adjusted odds ratios of receiving non-optimal anticoagulant therapy for Black patients were 1.13; 95 % CI, 1.02-1.30, p  = 0.02; and 1.17; 95%CI, 1.04-1.31, p  = 0.01; respectively, and 1.10; 95 % CI 1.03-1.18, p  = 0.005; and 1.36; 95 % CI, 1.25-1.47, p  < 0.001; for females compared with males. Conclusions and Relevance: In patients with atrial fibrillation in the University of Cincinnati Health system, Black race and female sex were independently associated with an increased odds of receiving non-optimal anticoagulant therapy. Competing Interests: Mark Eckman, Ruth Wise, Anthony Leonard, Pete Baker, Rob Ireton, Brett Harnett, Estrelita Dixon, Matthew Flaherty, Carol Knochelmann, Rachael Mardis, Sharon Wright, Ashish Gummadi, Richard Becker, Daniel Schauer, Alexandru Costea, Heidi Sucharew, Lora Anderson, and John Kues have investigator-initiated grant support from Bristol Myers Squibb-Pfizer Alliance through a grant from the Annual American Thrombosis Investigator Initiated Research Program (ARISTA) grant number CV-185-764. In addition, Mark Eckman has investigator-initiated grant support from NICHD grant number R011HD094213, and NCATS grant number UL1TR001425. In addition, Matthew Flaherty has the following support - NINDS, CSL Behring - speaker's bureau, Alexion Pharmaceuticals - speaker's bureau, Co-founder and equity holder - Sense Diagnostics, Inc., and Outcome event adjudication committee - Parexel. In addition, Richard Becker has the following support - Ionis DSMB, Novartis DSMB, Merck Scientific advisory for factor XI inhibitor development, and Basking Biosciences advisory for VWF inhibitor development. Adeboye Adejare now works for Janssen Pharmaceuticals. (© 2022 The Authors.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu