Advocate Aurora Research Institute, Downers Grove, IL, United States of America.
Pfizer Inc, US Medical Affairs, New York, NY, United States of America.
PLoS One. 2023 Aug 10;18(8):e0289708. doi: 10.1371/journal.pone.0289708. eCollection 2023.
Patient clinical factors and social determinants of health (SDOH) are associated with an increased risk of stroke for patients with atrial fibrillation (AF); however, the association between these factors and the management of AF is not well characterized, particularly among those factors commonly collected in electronic health records (EHRs). This study used EHR data to evaluate the associations between patient clinical factors and SDOH and prescribing of an oral anticoagulant (OAC) for stroke prevention in AF.
This analysis included adult patients with newly diagnosed AF who had ≥2 encounters in the Advocate Aurora Health system in Wisconsin between May 2016 and May 2021. Patient-level demographics, comorbidities, medications, and SDOH were retrospectively extracted from EHRs. Area deprivation index (ADI) was linked to patient records as a measure of socioeconomic status.
Of 16,656 patients with AF, 10,898 (65.4%) were prescribed an OAC within the first year of diagnosis. Patients were less likely to be prescribed an OAC (relative risk [95% CI]) if they were widowed (0.98 [0.96-0.99] vs single) or had a history of alcoholism (0.86 [0.79-0.95] vs no history). Most patients (53.3%) received prescriptions from a primary care provider. A linear relationship was found between worsening ADI and increased prescriptions for warfarin vs those for direct-acting OACs.
Although guideline-concordant anticoagulant use remained suboptimal, clinical characteristics were strongly associated for whether a patient with AF would be prescribed an OAC. Disparities in patient care regarding the prescribing of OACs due to SDOH and associated behaviors were small but present, particularly for national ADI.
患者临床因素和社会决定因素（SDOH）与房颤（AF）患者中风风险增加有关；然而，这些因素与 AF 管理之间的关系尚未得到很好的描述，尤其是在电子健康记录（EHR）中通常收集的因素中。本研究使用 EHR 数据评估了患者临床因素和 SDOH 与 AF 中风预防中口服抗凝剂（OAC）处方之间的关联。
本分析包括 2016 年 5 月至 2021 年 5 月期间在威斯康星州的 Advocate Aurora Health 系统中至少有 2 次就诊的新诊断为 AF 的成年患者。从 EHR 中回顾性提取患者的人口统计学特征、合并症、药物和 SDOH。区域剥夺指数（ADI）与患者记录相关联，作为衡量社会经济地位的指标。
在 16656 名 AF 患者中，10898 名（65.4%）在诊断后的第一年被处方了 OAC。如果患者丧偶（0.98[0.96-0.99]与单身）或有酗酒史（0.86[0.79-0.95]与无酗酒史），则不太可能被处方 OAC（相对风险[95%置信区间]）。大多数患者（53.3%）从初级保健提供者那里获得了处方。发现 ADI 恶化与华法林处方增加与直接作用 OAC 处方增加之间存在线性关系。
尽管符合指南的抗凝剂使用仍然不理想，但 AF 患者是否接受 OAC 治疗的临床特征与是否接受 OAC 治疗密切相关。由于 SDOH 和相关行为导致的 OAC 处方患者护理方面的差异虽然很小，但确实存在，特别是对于全国 ADI 而言。
