Tate William J, White Darius, Ha Grace, Alzate James, Hayes Dolphurs, Ptaszek Leon M, Ruskin Jeremy, Betancourt Joseph R, Onuma Oyere, Wasfy Jason H, Wood Malissa J, Mansour Moussa
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
J Innov Card Rhythm Manag. 2025 Jun 15;16(6):6330-6340. doi: 10.19102/icrm.2025.16062. eCollection 2025 Jun.
Atrial fibrillation (AF) increases the risk of thromboembolic stroke, and oral anticoagulants (OACs) are an effective tool to reduce this risk. Previous studies have demonstrated that female, black, Hispanic, and Asian groups are less likely to be prescribed OACs. This study explores OAC rates by racial/ethnic group and assesses differences within sexes and between high and low CHADS-VASc risk groups. Using a database of AF patients, we employed logistic regression models to assess the association between race/ethnicity and OAC rates among all individuals and according to CHADS-VASc risk and sex subgroups. Black, Hispanic, and Asian individuals with AF had lower OAC rates compared to white individuals (adjusted odds ratio [aOR], 0.84; 95% confidence interval [CI], 0.77-0.91) (aOR, 0.92; 95% CI, 0.85-0.99) (aOR, 0.80; 95% CI, 0.72-0.88). Female patients with AF had lower OAC rates than male patients (aOR, 0.66; 95% CI, 0.64-0.68). Among male patients, black, Hispanic, and Asian patients had lower OAC rates while, among female patients, only black patients had a lower OAC rate. In the low-risk CHADS-VASc group, only Asian individuals had a lower OAC rate compared to white individuals, while, in the high-risk group, this trend was observed only for black individuals. Women, particularly black women, are less likely to receive OACs compared to men and their white counterparts. High-risk black individuals face reduced OAC use, while low-risk white individuals have high OAC rates. Subjective decision-making may contribute to these disparities, with the most significant disparities observed in black individuals, particularly black women. This "double hit" affecting black women could be the target of equity-focused interventions.
心房颤动（AF）会增加血栓栓塞性中风的风险，口服抗凝剂（OACs）是降低这种风险的有效手段。既往研究表明，女性、黑人、西班牙裔和亚裔群体接受OACs治疗的可能性较小。本研究探讨了不同种族/族裔群体的OACs使用率，并评估了性别之间以及CHADS-VASc高风险组和低风险组之间的差异。利用房颤患者数据库，我们采用逻辑回归模型评估种族/族裔与所有个体以及根据CHADS-VASc风险和性别亚组的OACs使用率之间的关联。与白人相比，患有房颤的黑人、西班牙裔和亚裔个体的OACs使用率较低（调整优势比[aOR]，0.84；95%置信区间[CI]，0.77-0.91）（aOR，0.92；95%CI，0.85-0.99）（aOR，0.80；95%CI，0.72-0.88）。患有房颤的女性患者的OACs使用率低于男性患者（aOR，0.66；95%CI，0.64-0.68）。在男性患者中，黑人、西班牙裔和亚裔患者的OACs使用率较低，而在女性患者中，只有黑人患者的OACs使用率较低。在CHADS-VASc低风险组中，与白人相比，只有亚裔个体的OACs使用率较低，而在高风险组中，这种趋势仅在黑人个体中观察到。与男性及其白人同龄人相比，女性，尤其是黑人女性，接受OACs治疗的可能性较小。高风险的黑人个体OACs使用减少，而低风险的白人个体OACs使用率较高。主观决策可能导致了这些差异，其中黑人个体，尤其是黑人女性的差异最为显著。这种影响黑人女性的“双重打击”可能是公平性干预措施的目标。
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