Tags

Type your tag names separated by a space and hit enter

Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation.
Heart Rhythm. 2015 Jul; 12(7):1406-12.HR

Abstract

BACKGROUND

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.

OBJECTIVE

We sought to determine whether significant race and sex differences exist in the treatment of newly diagnosed AF in Medicare beneficiaries.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Authors+Show Affiliations

University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: pdbhave@gmail.com.University of Iowa Hospitals and Clinics, Iowa City, Iowa.University of Iowa Hospitals and Clinics, Iowa City, Iowa.Feil Family Brain and Mind Research Institute, New York, New York; Department of Neurology, Weill Cornell Medical College, New York, New York.University of Iowa Hospitals and Clinics, Iowa City, Iowa; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Medical Center, Iowa City, Iowa.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

25814418

Citation

Bhave, Prashant D., et al. "Race- and Sex-related Differences in Care for Patients Newly Diagnosed With Atrial Fibrillation." Heart Rhythm, vol. 12, no. 7, 2015, pp. 1406-12.
Bhave PD, Lu X, Girotra S, et al. Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation. Heart Rhythm. 2015;12(7):1406-12.
Bhave, P. D., Lu, X., Girotra, S., Kamel, H., & Vaughan Sarrazin, M. S. (2015). Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation. Heart Rhythm, 12(7), 1406-12. https://doi.org/10.1016/j.hrthm.2015.03.031
Bhave PD, et al. Race- and Sex-related Differences in Care for Patients Newly Diagnosed With Atrial Fibrillation. Heart Rhythm. 2015;12(7):1406-12. PubMed PMID: 25814418.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation. AU - Bhave,Prashant D, AU - Lu,Xin, AU - Girotra,Saket, AU - Kamel,Hooman, AU - Vaughan Sarrazin,Mary S, Y1 - 2015/03/23/ PY - 2014/12/01/received PY - 2015/3/28/entrez PY - 2015/3/31/pubmed PY - 2016/4/28/medline KW - Atrial fibrillation KW - Disparities KW - Outcomes SP - 1406 EP - 12 JF - Heart rhythm JO - Heart Rhythm VL - 12 IS - 7 N2 - BACKGROUND: 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. OBJECTIVE: We sought to determine whether significant race and sex differences exist in the treatment of newly diagnosed AF in Medicare beneficiaries. METHODS: 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. RESULTS: 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). CONCLUSION: 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. SN - 1556-3871 UR - https://www.unboundmedicine.com/medline/citation/25814418/Race__and_sex_related_differences_in_care_for_patients_newly_diagnosed_with_atrial_fibrillation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1547-5271(15)00330-6 DB - PRIME DP - Unbound Medicine ER -