Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation

Prashant D Bhave; Xin Lu; Saket Girotra; Hooman Kamel; Mary S Vaughan Sarrazin

doi:10.1016/j.hrthm.2015.03.031

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Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation

Journal article

Peer reviewed

Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation

Prashant D Bhave, Xin Lu, Saket Girotra, Hooman Kamel and Mary S Vaughan Sarrazin

Heart rhythm, Vol.12(7), pp.1406-1412

07/2015

DOI: 10.1016/j.hrthm.2015.03.031

PMCID: PMC4787261

PMID: 25814418

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Abstract

Atrial fibrillation (AF) is associated with an increased risk of stroke and death. Uniform utilization of appropriate therapies for AF may help reduce those risks. We sought to determine whether significant race and sex differences exist in the treatment of newly diagnosed AF in Medicare beneficiaries. We used administrative encounter data for Medicare beneficiaries to identify patients with newly diagnosed AF during 2010–2011. Services received after initial AF diagnosis were cataloged, including visits with a cardiologist or electrophysiologist, catheter ablation procedures, and use of oral anticoagulants, rate control agents, and antiarrhythmic drugs. Overall, 517,941 patients met study criteria, of whom 452,986 (87%) were white, 36,425 (7%) black, and 28,530 (6%) Hispanic. Male patients comprised 209,788 (41%) of the cohort. In multivariate analysis, there were statistically significant differences in the use of AF-related services by both race and sex, with white patients and male patients receiving the most care. The most notable disparities were for catheter ablation (Hispanic vs white: adjusted hazard ratio [AHR] 0.70; 95% confidence interval [CI] 0.63–0.79; P < .001; female vs male: AHR 0.65; 95% CI 0.63–0.68; P < .001) and receipt of oral anticoagulation (black vs white: AHR 0.94; 95% CI 0.92–0.95; P < .001; Hispanic vs white: AHR 0.94; 95% CI 0.93–0.97; P < .001; female vs male: AHR 0.93; 95% CI 0.93–0.94; P < .001). Race and sex appear to have a significant effect on the health care provided to this cohort of Medicare beneficiaries diagnosed with AF. Possible explanations include racial differences in access, patient preferences, treatment bias, and unmeasured clinical characteristics.

Atrial fibrillation

Disparities

Outcomes

Details

Title: Subtitle: Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation
Creators: Prashant D Bhave - University of Iowa Hospitals and Clinics, Iowa City, Iowa
Xin Lu - University of Iowa Hospitals and Clinics, Iowa City, Iowa
Saket Girotra - University of Iowa Hospitals and Clinics, Iowa City, Iowa
Hooman Kamel - Feil Family Brain and Mind Research Institute, New York, New York
Mary S Vaughan Sarrazin - University of Iowa Hospitals and Clinics, Iowa City, Iowa
Resource Type: Journal article
Publication Details: Heart rhythm, Vol.12(7), pp.1406-1412
DOI: 10.1016/j.hrthm.2015.03.031
PMID: 25814418
PMCID: PMC4787261
NLM abbreviation: Heart Rhythm
ISSN: 1547-5271
eISSN: 1556-3871
Publisher: Elsevier Inc
Language: English
Date published: 07/2015
Academic Unit: Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Internal Medicine
Record Identifier: 9984063131902771

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