Abstract 18357: Racial Disparities in Direct Oral Anticoagulant Orders in Patients With Nonvalvular Atrial Fibrillation Within A Large Integrated Health System

Abstract

Introduction: Anticoagulant (OAC) use for stroke prevention in non-valvular atrial fibrillation (NVAF), specifically direct oral anticoagulants (DOAC) use, is suboptimal in racial/ethnic (RE) minorities. Hypothesis: We hypothesized differences in OAC and DOAC orders among RE groups over time in patients newly diagnosed with NVAF from 2012-2022 within a large US integrated healthcare system. Methods: We conducted a retrospective cohort study using Kaiser Permanente Southern California electronic medical record data on adults with NVAF between 2012-2022. We compared the proportion of OAC and DOAC orders within 60 days from the first NVAF diagnosis among those with a CHA 2 DS 2 -VASc score ≥2 across self-reported RE groups over time using chi-squared tests. Multivariable logistic regression was used to compare OAC and DOAC orders in RE groups compared with non-Hispanic White (NHW) adjusting for age, sex, and CHA 2 DS 2 -VASc score. Results: Of 59,340 OAC eligible patients from 2012-2022, 52% of patients received an OAC order and 33% received a DOAC order. DOAC orders across all RE groups increased over time, with DOAC orders comprising 95% of all OAC orders for new NVAF patients in 2022. The percentages of OAC and DOAC orders were highest among NHW patients in most years. In 2022, OACs were ordered at higher rates for NHW (67.1%) than Asian (67.0%) (OR=0.84, 95% CI=0.67-1.05), Hispanic (65.6%) (OR=0.63, 95% CI=0.54-0.74), or non-Hispanic Black (62.0%) (OR=0.54, 95% CI=0.43-0.68) patients. In 2022, DOACs were ordered at higher rates for NHW (65.3%) than Asian (64.2%) (OR=0.78, 95% CI=0.63-0.98), Hispanic (64.1%) (OR=0.64, 95% CI=0.55-0.75), or non-Hispanic Black (60.7%) (OR=0.55, 95% CI=0.44-0.69) patients ( Figures 1a/1b ). Conclusions: Although DOAC orders have been increasing over time across all RE groups, minority groups were still less likely to receive OAC or DOAC orders than NHW patients.