Abstract 12823: Racial Disparities and Geographic Variation in Anticoagulant Treatment Among Medicare Beneficiaries With Non-Valvular Atrial Fibrillation in the United States

Abstract

Introduction: Little is known about racial disparities and the geographic variation in oral anticoagulant (OAC) use throughout the United States (US) since the approval of direct oral anticoagulants (DOACs) as a safe alternative treatment compared to warfarin for non-valvular atrial fibrillation (NVAF). Methods: Patients with NVAF were selected from the US Centers for Medicare & Medicaid Services claims database (01JAN2013 to 31DEC2016). The final population consisted of patients with 12 months of health plan enrollment before and after the NVAF diagnosis and with a baseline CHAD 2 S 2 -VASc ≥ 2. Each patient was assigned a 3-digit zip code based on their primary residence. Results were stratified by race. Geographic variations within each race and differences between races were visualized using ArcGIS Pro software. Results: Of the 2,756,097 patients with NVAF and CHAD 2 S 2 -VASc ≥ 2, majority (88.9%) were White, and 6.3% were Black. Age and HASBLED scores ranged from 79 (Black) to 81 (White) and 3.4 (White) to 3.9 (Black), respectively. The CHAD 2 S 2 -VASc and CCI scores ranged from 5.1 (White) to 5.5 (Black) and 3.0 (White) to 4.3 (Black), respectively. In general, Black patients had a higher untreated rate with an OAC than Whites (Figures 1 and 2). There were also geographic variations in treatment rates mostly noted among Whites with lower rates in the mid-west compared to the south and west (Figure 2). Conclusion: OAC use by race varies considerably by 3-digit zip code in the US. Higher untreated rates and use of warfarin over DOACs in the Black population indicate a potential target for further research into disparities between races in availability of anticoagulant treatment.