Kipp Ryan, Herzog Lee-Or, Khanna Rahul, Zhang Dongyu
Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Franchise Health Economics and Market Access, Johnson and Johnson, Irvine, CA, USA.
Clinicoecon Outcomes Res. 2024 Mar 27;16:197-208. doi: 10.2147/CEOR.S457992. eCollection 2024.
Atrial fibrillation (AF) is associated with considerable morbidity and mortality. Timely management and treatment are critical in alleviating AF disease burden. There is significant heterogeneity in patterns of AF care. It is unclear whether there are racial and ethnic differences in treatment of AF following antiarrhythmic drug (AAD) prescription.
Using the Optum Clinformatics Data Mart-Socioeconomic Status database from January, 2009, through March, 2022, multivariable logistic regression techniques were used to examine the impact of race and ethnicity on rate of AAD initiation, as well as receipt of catheter ablation within two years of initiation. We compared AAD discontinuation rate by race and ethnicity groups using Cox regression models. Log-rank analyses were used to examine the rate of AF-related hospitalization.
Among 143,281 patients identified with newly diagnosed AF, 30,019 patients (21%) were initiated on an AAD within 90 days. Patients identified as Non-Hispanic Black (NHB) were significantly less likely to receive an AAD compared to Non-Hispanic White patients (NHW) (Odds Ratio [OR] 0.90, 95% confidence interval [CI] 0.85-0.94). Compared to NHW, Hispanic (Hazard Ratio [HR] 1.08, 95% CI 1.02-1.14) and Asian patients (HR 1.17, 95% CI 1.06-1.29) have a higher rate of AAD discontinuation. Following AAD initiation, NHB patients were significantly more likely to have an AF-related hospitalization (p < 0.01). However, NHB patients were significantly less likely to receive ablation compared to NHW (HR 0.83, 95% CI 0.70-0.97), and less likely to change AAD (p < 0.01).
Patients identified as NHB are 10% less likely to receive an AAD for treatment of newly diagnosed AF. Compared to NHW, Hispanic and Asian patients were more likely to discontinue AAD treatment. Once initiated on an AAD, NHB patients were significantly more likely to have an AF -related hospitalization, but were 17% less likely to receive ablation compared to NHW patients. The etiology of, and interventions to reduce, these disparities require further investigation.
心房颤动（AF）与相当高的发病率和死亡率相关。及时的管理和治疗对于减轻房颤疾病负担至关重要。房颤护理模式存在显著异质性。目前尚不清楚在开具抗心律失常药物（AAD）处方后，房颤治疗中是否存在种族和民族差异。
利用2009年1月至2022年3月的Optum临床信息数据集市 - 社会经济地位数据库，采用多变量逻辑回归技术来研究种族和民族对AAD起始率的影响，以及起始后两年内接受导管消融的情况。我们使用Cox回归模型比较不同种族和民族组的AAD停药率。对数秩分析用于研究房颤相关住院率。
在143,281例新诊断为房颤的患者中，30,019例患者（21%）在90天内开始使用AAD。与非西班牙裔白人患者（NHW）相比，被认定为非西班牙裔黑人（NHB）的患者接受AAD的可能性显著降低（优势比[OR]为0.90，95%置信区间[CI]为0.85 - 0.94）。与NHW相比，西班牙裔患者（风险比[HR]为1.08，95% CI为1.02 - 1.14）和亚洲患者（HR为1.17，95% CI为1.06 - 1.29）的AAD停药率更高。在开始使用AAD后，NHB患者发生房颤相关住院的可能性显著更高（p < 0.01）。然而，与NHW相比，NHB患者接受消融的可能性显著降低（HR为0.83，95% CI为0.70 - 0.97），且更换AAD的可能性更低（p < 0.01）。
被认定为NHB的患者接受AAD治疗新诊断房颤的可能性低10%。与NHW相比，西班牙裔和亚洲患者更有可能停止AAD治疗。一旦开始使用AAD，NHB患者发生房颤相关住院的可能性显著更高，但与NHW患者相比，接受消融的可能性低17%。这些差异的病因及减少差异的干预措施需要进一步研究。
