Atrial fibrillation complications are more severe in Black patients but they are less likely to be treated.
While Black patients are less likely to be diagnosed with atrial fibrillation than those of other races, they are more likely to experience severe symptoms such as strokes and even death. Three years ago, Utibe Essien, an assistant professor at the University of Pittsburgh, was studying 12,000 patients diagnosed with the condition to see where the disparities lie.
While oral anticoagulants can reduce the risk of stroke in atrial fibrillation patients by up to 70%, in the study, Essien wrote, “We found that Black patients were less likely to receive these blood thinners and especially the newer class of blood thinner medications or direct oral anticoagulants.” Existing literature typically cites social and economic factors for the reasons why such disparities exist. Essien wanted to unpack this a bit more and, to do so, pulled data from the U.S. Department of Veterans Affairs (VA).
In analyzing his findings, Essien determined, “Black and Asian patients had significantly lower adjusted odds ratios of receiving any OAC therapy than white patients in the fully adjusted model, and Black and Asian patients had significantly lower adjusted odds ratios of receiving any OAC therapy than white patients in the fully adjusted model.”
“So regardless of where you’re getting your care – here in Pennsylvania or out in California – you have the same access to the medications that every other veteran has, and you’re paying the same amount,” he explained.
In 2019, Essien and his research team inspected data from more than 111,000 VA patients nationwide with atrial fibrillation in the four-year span from 2014 to 2018. “After adjusting for clinical, sociodemographic, provider and facility factors,” the new study indicated that “Black and Asian patients were significantly less likely than white patients to be prescribed blood thinners.” Thus, these disparities exist within the VA’s system as well.
For a long time, warfarin was the only oral anticoagulant available for stroke prevention in patients, but it came with some significant risk factors. According to Magnani, “When people are treated with anticoagulants, there is a background risk of stroke, and that risk is higher in individuals who are taking warfarin than in those who are taking the more contemporary medications. And people who are on warfarin have a greater risk for bleeding events than those on the more contemporary agents.”
“Warfarin also requires patients to monitor their diets and other medications to ensure there are no negative interactions,” said Essien. “It’s not just an inconvenience to a lot of patients, but it’s quite challenging to control. And there [has] been almost a decade-plus of data showing that patients who have more challenging social situations really have a difficult time taking warfarin and being well-controlled on it. And if you’re not well-controlled on warfarin, you have a high risk of developing a stroke.”
The team looked at other anticoagulants that have been introduced to the market over the years and found Black, Hispanic, and American Indian/Alaska Native patients were less likely to receive those blood thinners as well.
“In a system like the VA in which patients have complete access to care,” Magnani said, “there shouldn’t be a patient-level barrier that impedes individual access to care. I think that we’re seeing the downstream effects of social inequities and structural racism that are broadly a part of our society.”