Racial Disparities in Treatment of Atrial Fibrillation

November 11th, 2021

Atrial fibrillation is a heart condition that results in an irregular heartbeat and can lead to higher risks for cardiovascular disease, including stroke. Treatment with blood thinning drugs may reduce the risk of stroke by as much as 70% and is the standard of care for atrial fibrillation, but a recent study showed that members of minority communities with the disease are less likely to be treated with blood thinners than white patients.

The study examined Veterans Health Administration (VA) system medical records across the nation collected between 2014 and 2018; data from 111,666 patients diagnosed with atrial fibrillation were reviewed to analyze information about the therapeutic use of blood thinning medications. Patient use of two types of anticoagulants were examined: oral anticoagulants (OACs) and direct oral anticoagulants (DOACs). Of the two, DOACs were more recently developed and are becoming increasingly accepted as the preferred standard of care. 

The study found significantly lower initiation of any OACs in Asian and Black populations than in white populations, and lower initiation of DOACs in Black, Hispanic, and Native American/Alaskan Native populations. This has critical implications for patient care, especially because negative outcomes associated with the disease, like stroke, disproportionately affect racial and ethnic minorities.

Study investigator and University of Pittsburgh professor Utibe R. Essien, MD, MPH, explains the importance of these findings: “Understanding the reasons for these treatment disparities is essential to improving equitable atrial fibrillation management and outcomes among racial and ethnic minority patients managed in the VA. Providers play a big role, but so does the broader health system. This includes ensuring there is equity in whether patients are referred to cardiologists or our pharmacy colleagues, who have been shown to be more likely to prescribe these medications in atrial fibrillation.”