Among hemodialysis patients with atrial fibrillation, racial/ethnic disparities in all-cause stroke are partially mediated by lower anticoagulant use, according to a study published online Feb. 20 in the Journal of the American Society of Nephrology.
Salina P. Waddy, M.D., from Atlanta Veterans Affairs Medical Center in Decatur, Georgia, and colleagues identified end-stage kidney disease (ESKD) patients who initiated hemodialysis from 2006 to 2013 and had a subsequent atrial fibrillation diagnosis. Patients were followed for all-cause stroke, mortality, prescription medications, and cardiovascular disease procedures for one year. The percentage of excess strokes attributable to lower use of atrial fibrillation treatments was examined by race/ethnicity.
A total of 56,587 ESKD hemodialysis patients with atrial fibrillation were included in the study. The researchers found that black, Hispanic, and Asian patients were more likely to experience stroke than white patients (13, 15 and 16 percent, respectively), but were less likely to fill a warfarin prescription (10, 17, and 28 percent, respectively). There was an association for warfarin prescription with decreased stroke rates. Equalizing the warfarin distribution among black, Hispanic, and Asian patients to that in the white population could prevent 7, 10, and 12 percent of excess strokes, respectively.
“Consideration of population health initiatives may help change physician behavior to be attuned to racial/ethnic disparities, ensure optimal treatment in these groups, and reduce unjust and unfair differences in patient management by race/ethnicity,” the authors write.
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