TY - JOUR
T1 - Disparities and Temporal Trends in the Use of Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation
AU - Sur, Nicole B.
AU - Wang, Kefeng
AU - Di Tullio, Marco R.
AU - Gutierrez, Carolina M.
AU - Dong, Chuanhui
AU - Koch, Sebastian
AU - Gardener, Hannah
AU - García-Rivera, Enid J.
AU - Zevallos, Juan Carlos
AU - Burgin, W. Scott
AU - Rose, David Z.
AU - Goldberger, Jeffrey J.
AU - Romano, Jose G.
AU - Sacco, Ralph L.
AU - Rundek, Tatjana
N1 - Funding Information:
This work was supported by a grant from the National Institute of Neurological Disorders and Stroke (U54NS081763) and a grant from Bristol-Myers Squibb (CV185-564). FLiPER-AF (Florida Puerto Rico Atrial Fibrillation) is registered under https://www.clinicaltrials. gov; unique identifier: NCT03627806.
Funding Information:
Dr Sur reports National Institutes of Health (NIH) StrokeNet institutional grant (1U24NS107267). Dr Di Tullio reports NIH research grants. Dr Koch reports support from National Institute of Neurological Disorders and Stroke (U54NS081763) and Bristol-Myers Squibb (CV185-564). Dr Rose belongs to the speaker’s bureau for Boehringer Ingelheim, Boston Scientific, and CSL Behring. Dr Romano reports stocks at Vycor/NovaVision; research grants from NIH/National Institute on Minority Health and Health Disparities TCSD-S study (Transitions of Care Stroke Disparities Study; 1R01MD012467), NIH/National Institute of Neurological Disorders and Stroke (1R01NS084288), StrokeNet (1U24NS107267), Florida-Puerto Rico Collaboration to Reduce Stroke Registry (FL-PR CReSD; SPIRP [Stroke Prevention/Intervention Research Program]; U54 NS-081763); role as principal investigator of the MaRISS (Mild and Rapidly Improving Stroke Study) at Genentech; consulting at Genentech for Steering Committee role of the PRISMS study (Potential for r-tPA to Improve Stroke With Mild Symptoms); advisor at Vycor/ NovaVision. Dr Sacco reports support from National Institute of Neurological Disorders and Stroke FL-PR CReSD (U54NS081763), Boehringer Ingelheim, NIH/National Institute on Minority Health and Health Disparities TCSD-S Study (1R01MD012467), and StrokeNet (1U24NS107267). Dr Rundek reports support from National Institute of Neurological Disorders and Stroke FL-PR CReSD (U54NS081763), Bristol-Myers Squibb (CV185-564), NIH/National Institute on Minority Health and Health Disparities TCSD-S Study (R01MD012467), and StrokeNet (U24NS107267).
Publisher Copyright:
© 2019 American Heart Association, Inc.
PY - 2019
Y1 - 2019
N2 - Background and Purpose-Ischemic stroke (IS) secondary to atrial fibrillation (AF) is largely preventable with the use of anticoagulation. We sought to identify race-ethnicity and sex disparities with the use of direct oral anticoagulants (DOACs), aspirin, and warfarin in IS patients with AF and to identify temporal trends in the utilization of these medications. Methods-The FLiPER-AF Stroke Study (Florida Puerto Rico Atrial Fibrillation) included 24 040 IS cases enrolled in the Florida-Puerto Rico Collaboration to Reduce Stroke Registry from 2010 to 2016. Multivariable logistic regression models were performed to evaluate the effect of race-ethnicity and sex on utilization of DOACs, aspirin, and warfarin for stroke prevention in AF after adjustment for sociodemographic, hospital, and clinical factors. Results-Among 24 040 IS cases, 54% were women and 10% black, 12% FL-Hispanics, 4% PR-Hispanic, and 74% whites. From 2010 to 2016, DOAC use increased from 0% to 36%, warfarin use decreased from 51% to 17%, and aspirin use remained relatively stable (42%-40%). After adjustment, blacks had higher odds of warfarin (odds ratio, 1.22; 95% CI, 1.07-1.40) prescription at discharge compared with whites. Men had higher rates of aspirin (42.1% versus 38.8%), warfarin (33.6% versus 28.9%), and DOAC (21.3% versus 19.3%) use compared with women. After adjustment, women had lower odds of being discharged on aspirin (odds ratio, 0.92; 95% CI, 0.86-0.98) or warfarin (odds ratio, 0.91; 95% CI, 0.84-0.99). There was no sex difference in use of DOACs. Conclusions-Our study confirmed the increasing use of DOACs, downtrending use of warfarin, whereas aspirin use remained similar over the years. There are sex and race-ethnicity disparities in anticoagulation use in IS patients with AF. It is critical to understand underlying drivers of these disparities to develop better practice strategies for stroke prevention in patients with AF. Clinical Trial Registration-URL: https://www.clinicaltrials.gov. Unique identifier: NCT03627806.
AB - Background and Purpose-Ischemic stroke (IS) secondary to atrial fibrillation (AF) is largely preventable with the use of anticoagulation. We sought to identify race-ethnicity and sex disparities with the use of direct oral anticoagulants (DOACs), aspirin, and warfarin in IS patients with AF and to identify temporal trends in the utilization of these medications. Methods-The FLiPER-AF Stroke Study (Florida Puerto Rico Atrial Fibrillation) included 24 040 IS cases enrolled in the Florida-Puerto Rico Collaboration to Reduce Stroke Registry from 2010 to 2016. Multivariable logistic regression models were performed to evaluate the effect of race-ethnicity and sex on utilization of DOACs, aspirin, and warfarin for stroke prevention in AF after adjustment for sociodemographic, hospital, and clinical factors. Results-Among 24 040 IS cases, 54% were women and 10% black, 12% FL-Hispanics, 4% PR-Hispanic, and 74% whites. From 2010 to 2016, DOAC use increased from 0% to 36%, warfarin use decreased from 51% to 17%, and aspirin use remained relatively stable (42%-40%). After adjustment, blacks had higher odds of warfarin (odds ratio, 1.22; 95% CI, 1.07-1.40) prescription at discharge compared with whites. Men had higher rates of aspirin (42.1% versus 38.8%), warfarin (33.6% versus 28.9%), and DOAC (21.3% versus 19.3%) use compared with women. After adjustment, women had lower odds of being discharged on aspirin (odds ratio, 0.92; 95% CI, 0.86-0.98) or warfarin (odds ratio, 0.91; 95% CI, 0.84-0.99). There was no sex difference in use of DOACs. Conclusions-Our study confirmed the increasing use of DOACs, downtrending use of warfarin, whereas aspirin use remained similar over the years. There are sex and race-ethnicity disparities in anticoagulation use in IS patients with AF. It is critical to understand underlying drivers of these disparities to develop better practice strategies for stroke prevention in patients with AF. Clinical Trial Registration-URL: https://www.clinicaltrials.gov. Unique identifier: NCT03627806.
KW - atrial fibrillation
KW - cerebrovascular disorders
KW - humans
KW - warfarin
KW - women
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U2 - 10.1161/STROKEAHA.118.023959
DO - 10.1161/STROKEAHA.118.023959
M3 - Article
C2 - 31084325
AN - SCOPUS:85067266560
VL - 50
SP - 1452
EP - 1459
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 6
ER -