- A new study suggets Black patients are less likely to be given oral anticoagulants (OAC) upon being discharged from the hospital.
- As a result, they have a greater risk of stroke and death.
- Prescribing oral anticoagulants can help reduce the risk of stroke in patients with atrial fibrillation, a type of arrhythmia.
Black patients who are hospitalized with atrial fibrillation are less likely to be prescribed anticoagulant medications and more likely to experience worse health outcomes compared to white patients, according to new research from scientists at University of Pittsburgh School of Medicine.
The study, which published in
The new findings add to existing evidence showing that Black patients are less likely to receive newer anticoagulant medications than white patients.
Prescribing OACs can help reduce the risk of stroke in patients with atrial fibrillation, a type of arrhythmia.
“It is public health problem if communities of color are put at a disproportionate risk of stroke and death because of under-prescribing,” says Bernadette Boden-Albala, Director and Founding Dean of the Program in Public Health Public Health at the University of California, Irvine.
For the study, the researchers evaluated the health of nearly 70,000 patients who had been hospitalized with atrial fibrillation between 2014 and 2020.
The research team found that Black patients were 25% less likely to be given an anticoagulation medication at discharge compared to white patients. OAC use was even lower among Hispanic patients.
Black and Hispanic patients were also less likely to receive newer, more effective anticoagulation treatments — even among patients who had the highest risk of stroke.
The research team followed up with the patients one year later and found that the under-prescribing of anticoagulation among Black patients was associated with a heightened risk of stroke, bleeding, and mortality.
Black patients had a two-fold greater risk stroke and a 1.2 times higher risk of death. Hispanic patients had a similarly heightened risk of stroke.
The researchers say the findings highlight an urgent need to address racial inequities in prescribing patterns in order to improve health outcomes.
“Clearly, urgent interventions at the hospital system level are needed to mitigate the problem of differential distributions of OAC prescriptions,” Boden-Albala said.
According to Dr. Isaac Whitman, Associate Professor of Medicine in the Section of Cardiac Electrophysiology at Temple University Hospital, the racial disparities can be attributed to inequities in access to healthcare, the way healthcare is provided, and the overall health of underrepresented racial and ethnic groups.
Past research shows clinician bias, misattribution and perception of risk, and cost of treatment influence racial inequities.
But Whitman says the solution isn’t as simple as prescribing OACs to more patients hospitalized with atrial fibrillation.
Though these medications reduce one’s risk of stroke, they also increase the risk of bleeding.
“After all, that could even increase the risk of bleeding in underrepresented racial and ethnic groups even more, and may or may not reduce the risk of stroke,” Whitman said.
When determining whether to prescribe OACs, doctors evaluate a patient’s risk of stroke, bleeding, and other patient factors such as their arrhythmia and patient preferences, says Whitman.
Future studies will need to dig into the barriers and unmeasured variables — “such as an increased risk of bleeding in those patients,” Whitman says” — that could explain the reduced likelihood of Black patients being prescribed OACs at discharge.
The study highlights that there are disparities in the use of OACs and patient health outcomes after atrial fibrillation, however, more research is needed to develop targeted solutions that can combat these racial inequities.
“This study doesn’t get us there yet. But it adds to the massive body of literature that continues to paint a picture of inequality across races and ethnicities in our country,” Whitman said.
Black patients hospitalized with atrial fibrillation are less likely to be prescribed anticoagulant medications and more likely to experience stroke, bleeding, and death, according to new research. The study adds to existing evidence that Black and Hispanic patients are less likely to receive life-saving anticoagulants. More research is needed to determine if there are other factors behind the reduced likelihood of being prescribed anticoagulants, however, the findings show there are clear racial disparities in how anticoagulants are prescribed.