Racial/ethnic disparities in atrial fibrillation treatment and outcomes in us dialysis patients

Poster: Racial/Ethnic Disparities in Atrial Fibrillation Treatment and Outcomes in US Dialysis Patients

Presenter: Adan Z. Becerra PhD, Social & Scientific Systems

Authors: Paul L. Kimmel, MD, FASN, National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Salina Paulette Waddy, MD, Atlanta Veterans Administration, Allen J. Solomon, MD, The George Washington University, Adan Z. Becerra PhD, Social & Scientific Systems, Julia B. Ward, PhD, MPH, Social & Scientific Systems, Inc., Kevin Chan, MD, MS, MGH, Chyng-Wen Fwu PhD, Social & Scientific Systems, Inc., Jenna M. Norton MPH, NIH/NIDDK, Paul Eggers PhD, Kevin C. Abbott, MD, MPH, The National Institutes of Health, NIDDK,

Increased racial/ethnic disparities in stroke rates among end-stage renal disease (ESRD) dialysis patients with atrial fibrillation (AF) are partially explained by lower use of oral anticoagulants among Blacks, Hispanics, and Asians. The reasons for these racial disparities in practice are unknown, although the results support an identified need to develop strategies that will maximize stroke prevention in minority populations and resolve system barriers between patient/physician that may block optimal treatment.

The poster authors began with two facts:

1. Stroke prevention is a major goal in the management of end-stage renal disease (ESRD) dialysis patients with atrial fibrillation (AF).
2. In the general, among the AF population, racial/ethnic minorities have higher stroke rates, lower rates of anticoagulation, and higher anticoagulation complication rates.

The poster goes on to describe differential treatment patterns by race/ethnicity and their association with racial/ethnic disparities in stroke outcomes among dialysis patients with AF. To reach the final conclusion, the study looked at 56,587 ESRD dialysis patients with AF, including Black, non-Hispanic White, Hispanic, and Asian patients — which accounted for 19 percent, 69 percent, 8 percent, and 3 percent of the population respectively.

In adjusted analyses, Black, Hispanic, and Asian patients were 13 percent, 18 percent, and 22 percent respectively more likely to experience stroke within 1 year and 10 percent, 17 percent, and 28 percent respectively less likely to fill a prescription for warfarin compared to White patients. Prescription of warfarin was associated with decreased stroke rates (HR=0.82). Mediation analyses suggested that 7 percent, 10 percent, and 12 percent of excess strokes among Black, Hispanic, and Asian patients respectively could be prevented if the warfarin distributions in these groups were equalized to that in the White population.

The poster authors did not find racial/ethnic disparities for all-cause mortality or use of CVD procedures. All results achieved p<0.05.