Racial and Sex Disparities in Anticoagulation After Electrical Cardioversion for Atrial Fibrillation and Flutter

Amgad Mentias; Shady Nakhla; Milind Y Desai; Oussama Wazni; Venu Menon; Samir Kapadia; Mary Vaughan Sarrazin

doi:10.1161/JAHA.121.021674

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Racial and Sex Disparities in Anticoagulation After Electrical Cardioversion for Atrial Fibrillation and Flutter

Journal article

Open access

Peer reviewed

Racial and Sex Disparities in Anticoagulation After Electrical Cardioversion for Atrial Fibrillation and Flutter

Amgad Mentias, Shady Nakhla, Milind Y Desai, Oussama Wazni, Venu Menon, Samir Kapadia and Mary Vaughan Sarrazin

Journal of the American Heart Association, Vol.10(17), pp.e021674-e021674

09/07/2021

DOI: 10.1161/JAHA.121.021674

PMCID: PMC8649240

PMID: 34431314

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Abstract

Background Anticoagulation is indicated for 4 weeks after cardioversion in patients with atrial fibrillation/flutter. We sought to examine whether there is evidence of sex or racial disparity in anticoagulant prescription following cardioversion, and whether postcardioversion anticoagulation affects outcomes. Methods and Results We identified a representative sample of Medicare patients who underwent elective electric cardioversion in an outpatient setting from 2015 to 2017. We identified patients who had an anticoagulant prescription for 3 months after the cardioversion date. Multivariable logistic regression was used to assess factors associated with a prescription of an anticoagulant after cardioversion. Cox regression analysis was used to test association of anticoagulation with a composite end point of 90-day mortality, ischemic stroke, or arterial embolism. The final study cohort included 7860 patients. Overall, 5510 patients (70.1%) received any anticoagulation following cardioversion, while 2350 (29.9%) did not. Patients who did not receive anticoagulation were younger, with a lower burden of most comorbidities. Patients were less likely to receive anticoagulation if they had dementia or atrial flutter, while patients with valvular heart disease, obesity, heart failure, peripheral vascular or coronary disease, or hypertension were more likely to receive anticoagulation. Female sex (adjusted odds ratio, 0.84; 95% CI, 0.75-0.92; <0.001), Black and Hispanic race (adjusted odds ratio, 0.50; 95% CI, 0.38-0.65; and odds ratio, 0.56; 95% CI, 0.41-0.75, respectively; <0.001) were independently associated with lower probability of anticoagulant prescription. Postcardioversion anticoagulation was associated with lower risk of the composite end point (adjusted hazard ratio, 0.38; 95% CI, 0.27-0.52; <0.001). Conclusions Racial and sex disparities exist in anticoagulant prescription after outpatient elective cardioversion for atrial fibrillation.

Anticoagulants - therapeutic use

Atrial Fibrillation - drug therapy

Atrial Flutter - therapy

Electric Countershock

Female

Healthcare Disparities

Humans

Male

Medicare

Race Factors

Sex Factors

United States - epidemiology

Details

Title: Subtitle: Racial and Sex Disparities in Anticoagulation After Electrical Cardioversion for Atrial Fibrillation and Flutter
Creators: Amgad Mentias - University of Iowa
Shady Nakhla - Cleveland Clinic
Milind Y Desai - Cleveland Clinic
Oussama Wazni - Cleveland Clinic
Venu Menon - Cleveland Clinic
Samir Kapadia - Cleveland Clinic
Mary Vaughan Sarrazin - Iowa City VA Medical Center
Resource Type: Journal article
Publication Details: Journal of the American Heart Association, Vol.10(17), pp.e021674-e021674
DOI: 10.1161/JAHA.121.021674
PMID: 34431314
PMCID: PMC8649240
NLM abbreviation: J Am Heart Assoc
ISSN: 2047-9980
eISSN: 2047-9980
Grant note: R01 AG055663 / NIA NIH HHS
Language: English
Date published: 09/07/2021
Academic Unit: Health Management and Policy; General Internal Medicine; Internal Medicine
Record Identifier: 9984359791702771

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