NCDR Study Finds Disparities in AFib Treatment Among American Indian/Alaskan Native Patients

Journal of the American College of Cardiology

American Indian/Alaskan Native (AI/AN) patients with atrial fibrillation (AFib) are less likely than non-AI/AN patients to receive oral anticoagulation (OAC) or rhythm control strategies, according to a study published May 25 in the Journal of the American College of Cardiology.

Umair Khalid, MD, et al., used data from ACC and Veradigm's PINNACLE Registry to compare baseline characteristics and treatment strategies among AI/AN patients with AFib to those among non-AI/AN patients. The study population consisted of 2,559 AI/AN patients and 857,907 non-AI/AN patients with AFib who were enrolled in the registry between 2008 and 2016.

Among all patients, 57.6% (448,795) were receiving OAC and 39.2% (305,624) were treated with rhythm control strategies, such as ablation and cardioversion. AI/AN patients were significantly less likely than non-AI/AN patients to be treated with OAC (54.9% vs. 57.6%; odds ratio [OR]: 0.84; 95% confidence interval [CI], 0.77-0.93) or rhythm control strategies (36.5% vs. 39.2%; OR, 0.90; 95% CI, 0.81-0.99). White patients were more likely than AI/AN patients to receive OAC and rhythm control strategies.

There were no significant differences in treatment with OAC and rhythm control strategies between AI/AN patients and black, Asian and Native Hawaiian patients. In addition, there were moderate practice-level variations for OAC (median OR, 1.48; 95% CI, 1.41-1.58) and rhythm control strategies (median OR, 1.75; 95% CI, 1.63-1.90).

According to the researchers, the findings document lower rates of OAC and rhythm control strategies among AI/AN patients and moderate practice-level variations in treatment strategies and "add to the concerning evidence of reduced rates of OAC and rhythm control therapies among patients of color."

Possible reasons for the disparities include clinical differences in AI/AN patients that require different treatment strategies, unequal access to health care, differences in insurance coverage and inability to afford medications.

The researchers conclude that future studies should look at the underlying causes for the disparities to "provide insights into these potential limitations, identify opportunities for improvement, and uncover clinical areas unique to the AI/AN patients that warrant further investigation."

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Atrial Fibrillation, Indians, North American, Oceanic Ancestry Group, Alaska, Registries, Cardiology, Insurance Coverage, Anticoagulants, Health Services Accessibility, National Cardiovascular Data Registries, PINNACLE Registry

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