Department of Internal Medicine, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
BMC Cardiovasc Disord. 2023 Nov 21;23(1):578. doi: 10.1186/s12872-023-03607-y.
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).
This retrospective study investigated 9513 patients in KPMAS's AF registry with CHADS score ≥ 2 over a 6-month period in 2021.
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 Black and White patients (70.8% vs. 73.1%, P = .03) and Asian and White patients (68.3% vs. 71.6%, P = .005). After adjusting for CHADS, this difference persisted for Black and White participants with CHADS scores of ≤3 (62.6% vs. 70.6%, P < .001) and for Asian and White participants with CHADS scores > 5 (68.0% vs. 79.3%, P < .001).
Black and Asian patients may have differing rates of appropriate anticoagulation when compared with White patients. Characterizing such disparities is the first step towards addressing treatment gaps in AF.
心房颤动（AF）是中风的主要原因，通过适当的口服抗凝（OAC）治疗可以降低 70%的中风风险。在全国范围内，即使在中风风险最高的患者群体中，AF 伴高血栓栓塞风险患者的适当抗凝率也低至 50%。本研究旨在评估 Kaiser Permanente 中大西洋州（KPMAS）内患者的适当抗凝率在性别、族裔和社会经济地位方面的差异。
这项回顾性研究调查了 2021 年 KPMAS 的 AF 登记处中 9513 名 CHADS 评分≥2 的患者，随访时间为 6 个月。
适当抗凝的患者比未适当抗凝的患者有更高的糖尿病、既往中风和充血性心力衰竭发生率。男性和女性的抗凝率无显著差异（71.8%对 71.6%，[OR]1.01；95%CI，0.93-1.11；P=0.76），也不受 SES-SVI 四分位数的影响。黑人和白人患者（70.8%对 73.1%，P=0.03）和亚裔和白人患者（68.3%对 71.6%，P=0.005）之间存在统计学显著差异。在调整 CHADS 评分后，对于 CHADS 评分≤3 的黑人和白人患者（62.6%对 70.6%，P<0.001）以及 CHADS 评分>5 的亚裔和白人患者（68.0%对 79.3%，P<0.001），这种差异仍然存在。
与白人患者相比，黑人和亚裔患者的适当抗凝率可能存在差异。描述这种差异是解决 AF 治疗差距的第一步。
