Abstract TP511: Disparities and Temporal Trends in the Use of Anticoagulation in Patients With Atrial Fibrillation: The FLorida PuErto Rico Atrial Fibrillation (FLiPER-AF) Stroke Study

Abstract

Background: Ischemic stroke (IS) is a known effect of atrial fibrillation (AF) and is largely preventable with the use of systemic anticoagulation. Direct oral anticoagulants (DOACs) effectively prevent IS in patients with AF, but DOAC utilization patterns vary. The goal of this study is to identify race-ethnic and sex disparities for the use of DOACs, aspirin, and warfarin at hospital discharge in IS patients with AF, and to identify temporal trends in the utilization of these medications in a large hospital stroke registry in Florida and Puerto Rico. Methods: The FLorida PuErto Rico Atrial Fibrillation (FLiPER-AF) Stroke Study included 28,036 IS cases enrolled in the Florida-Puerto Rico Collaboration to Reduce Stroke Registry from 2010 to 2017. Multivariable logistic regression models were performed to evaluate the effect of race-ethnicity and sex on utilization of DOACs, aspirin and warfarin for stroke prevention in AF after adjustment for systems of care, individual and clinical factors, including CHA2DS2-VASc scores. Results: Among 28,036 IS cases, 74% were women and 9.9% Black, 12.5% FL Hispanics, 3.3% PR Hispanic and 74.3% whites. Overall, DOAC use increased from 0% in 2010 to 44.3% in 2017, while warfarin use decreased from 55.0% to 13.5%, in 2010 and 2017, respectively. Aspirin use remained stable overall, 42.3% in 2010 and 43.8% in 2017. After adjustment, Blacks had lower odds of being discharged on DOACs (OR=0.85, 95% CI 0.77-0.94) and higher odds of being discharged on warfarin (OR=1.13, 95% CI 1.02-1.25) compared to Whites. Men had higher rates of aspirin (42.1% vs 38.8%), warfarin (33.6% vs. 28.9%) and DOAC (21.3% vs, 19.3%) prescription compared to women. After adjustment, women had lower odds of being discharged on aspirin (OR=0.91, 95% CI 0.86-0.96) or warfarin (OR=0.90, 95% CI 0.85-0.96); however, there was no difference in use of DOACs. Conclusions: Our study confirmed the increasing use of DOACs and down-trending use of warfarin in IS patients with AF. However, Blacks were discharged on DOACs less frequently than Whites and women were discharged on anticoagulation less frequently than men. Further studies to understand underlying drivers of these disparities are needed to develop better practice strategies for stroke prevention for AF.