According to a new study conducted in the UK and published on 7 June in an open access journal, there is racial and socioeconomic inequality in prescribing oral anticoagulants to reduce the risk of stroke in people with atrial fibrillation. MEDICINE PLOS Alya Ajabnur of the University of Manchester, UK, and his colleagues.
Atrial fibrillation (AF) is one of the most important risk factors for future stroke, and currently the treatment of choice is oral anticoagulants (UACs). However, studies report frequent underutilization of KLA in patients with AF. Ajabnur and his colleagues used electronic medical records from a general practitioner in England as reported in the UK Clinical Practice Research Datalink (CPRD) database to assess the incidence of non-valvular Atrial fibrillation (NVAF) and trends in OAC appointments.
The study found the following:
- NVAF rates per 100,000 person-years increased from 20.8 (95% CI 20.4-21.1) in 2009 to 25.5 (95% CI 25.1-25.9) in 2019 and were noticeably higher among men.
- Among patients with NVAF eligible for anticoagulants, the number of OAC appointments increased by almost a quarter from 59.8% (95% CI 59.0-60.6) in 2009 to 83.2% (95% CI 83.0). -83.4) in 2019.
- Compared with white patients, patients from blacks (AS 0.78, 95% CI 0.65–0.94) and other ethnic minorities (AS 0.76, 95% CI 0.64–0.91) were less likely to receive KLA .
- Patients living in the poorest areas were also less likely to receive OAC compared to those in the most dangerous areas (OR0.85, 95% CI0.79-0.91).
- An association between OAC prescriptions and clinical factors including dementia, liver disease, malignancies, and history of falls has also been observed.
The study was limited to the fact that the data depended on an accurate record of conditions health professionals, and there may have been additional confusing factors related to the under-assignment of OACs. However, the authors conclude that clinical and socio-demographic factors play a role in the under-appointment of the KLA.
“Our findings suggest that to improve AF outcomes, these inequalities need to be addressed through equitable intervention to improve the purpose of SLAs to prevent stroke and reduce mortality,” the authors say.
Ajabnur adds: “Our study reveals deep inequalities in the care of patients with atrial fibrillation.”
Frequency of valvular atrial fibrillation and prescribing oral anticoagulants in England, 2009 to 2019: a cohort study. Medicine PLoS (2022). DOI: 10.1371 / journal.pmed.1004003
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