Patients with Atrial Fibrillation in Deprived Neighborhoods Are Less Likely to Receive Anticoagulants for Stroke Prevention

By: Sheila Davis

For people with atrial fibrillation (AFib), anticoagulation is the standard of care to prevent strokes. However, there is limited research into the neighborhood people live in and their access to these drugs. Neighborhood characteristics, such as levels of poverty, employment and education, have been related to various health outcomes. One measure to examine neighborhood social and economic characteristics is the area deprivation index (ADI).

Toluwa Omole

In a recent study published in the American Journal of Preventative Cardiology, researchers at the University of Pittsburgh and UPMC found that individuals in the most deprived neighborhoods had a 16% lower likelihood of receiving anticoagulants than those in the least deprived neighborhoods following an AFib diagnosis.

“I knew there would be a disparity, but I didn’t expect to see one of this magnitude,” said Toluwa Omole, study co-author and a student at Pitt’s School of Medicine. “We wanted to see if where people live affects whether they can get the care they need.”

Omole said they also found that patients receiving anticoagulants living in the most disadvantaged neighborhoods had a 24% lower likelihood of receiving a direct oral anticoagulant (DOAC) prescription as opposed to a warfarin prescription compared with those in the least disadvantaged neighborhoods.

Dr. Jared Magnani, the corresponding study author and UPMC cardiologist, points out that warfarin is a “challenging” medication compared to DOACs because patients must have their blood levels checked occasionally.

Dr. Jared Magnani

“DOACs are more convenient than warfarin, and there is good evidence that DOACs result in reduced bleeding and improved stroke prevention,” said Magnani. “That reduced likelihood to receive a DOAC showed that patients in the most disadvantaged neighborhoods aren’t getting the most appropriate medicine that would help prevent strokes.”

Researchers analyzed UPMC records for patients with atrial fibrillation from 2015-2020. They used a patient’s residential address to examine the relationship between ADI and whether the patient received a prescribed anticoagulant within 90 days following their AFib diagnosis.

They designed the study and took it to UPMC’s health care data and analytics team, which harvested the records, created a dataset and analyzed the data to provide the results.

“We can incorporate residence into our evaluation of patients and consider social risk factors,” said Magnani. “Addressing these problems requires commitment and funding, but we need to figure out avenues to provide more equitable care to disadvantaged populations.”

Pitt researchers have conducted similar studies in recent years looking into health disparities in treating cardiac issues, including a study that found people living in socioeconomically disadvantaged communities were at higher risk of hospital readmission and mortality for heart failure, myocardial ischemia and atrial fibrillation. Other research found racial disparities in anticoagulant use for patients with AFib within the U.S. Department of Veteran’s Affairs.

Omole and Magnani will continue to investigate the association of social factors – including a patient’s ability to access and pay for anticoagulants – and how they affect a patient’s ability to adhere to that medication.