PO-718-03 IDENTIFYING AND CHARACTERIZING PATIENTS WITH ATRIAL FIBRILLATION AND ELEVATED THROMBOEMBOLIC RISK WHO ARE NOT APPROPRIATELY ANTICOAGULATED

Abstract

Atrial fibrillation (AF) is the leading cause of stroke, which can be reduced by 70% with appropriate use of anticoagulation therapy. Nationally, appropriate anticoagulation rates for patients with AF with elevated thromboembolic risk are as low as 50% even across the highest CHADS2VASC score cohorts. Understanding anticoagulation fallout rates among gender, ethnicity, and socioeconomic status is an important first step towards decreasing the risk of thromboembolic events. This study aims to evaluate the variability of appropriate anticoagulation rates among patients with different gender, ethnicity, and socioeconomic status within the Kaiser Permanente Mid-Atlantic States (KPMAS) AF population. This retrospective study investigated 9513 patients in KPMAS’s AF registry with CHADS2 score >2 over a 6 month period from March to September 2021. We compared appropriate rates of anticoagulation across subsets of gender, ethnicity, and socioeconomic status by social vulnerability index socioeconomic status (SVI-SES) quartile. Rates were compared using Pearson's Chi-squared tests with SAS Version 9.4. Appropriately anticoagulated patients had higher rates of diabetes, prior stroke, and congestive heart failure than patients who were not appropriately anticoagulated. There were no differences in anticoagulation rates between males and females (71.8% vs. 71.6% [OR] 1.01; 95% CI, 0.93-1.11; P =.76). There was a statistically significant difference between blacks and whites (70.8% vs. 73.1%, P =.03) and Asians and whites (68.3% vs. 71.6%, P=.005). After adjusting for CHADS2 risk factors, this difference persisted for blacks and whites with CHADS2 scores of 2 (62.6% vs. 70.6%, P<.001) and for Asians and whites with CHADS2 scores >5 (68.0% vs. 79.3%, P<.001).There were no differences in anticoagulation rates between SES-SVI quartile. Appropriate anticoagulation rates within KPMAS appear to be higher than what has been reported in National Registry data. There was no difference in appropriate anticoagulation between males and females. Asians and blacks may have a lower rate of appropriate anticoagulation when compared with white patients. Characterizing such disparities is the first step towards addressing treatment gaps in atrial fibrillation.