부산대학교 도서관

Background: Despite a lower prevalence of AF, black patients with AF are at an increased risk of stroke compared with white patients.Objective: To assess for racial differences in patient characteristics and oral anticoagulation (OAC) use at discharge in hospitalized AF patients.Methods: A retrospective analysis was performed using the Premier Healthcare Database (1 in 5 US hospital discharges). Patients included were admitted between January 2011 and June 2015 with a primary or secondary AF diagnosis, CHA2DS2VASc score ≥2, and length of stay >1 day. Exclusion criteria included presence of a mechanical heart valve, any bleed or major surgery during admission, discharge to hospice, or transfer to an acute care facility. Logistic regression modeling was performed to adjust for racial differences in clinical and hospital characteristics for the prescription of oral anticoagulation use.Results: Among 1,579,456 admissions in 812 hospitals, black patients comprised 126,002 (8.0%); white 1,282,550 (81.2%). Compared to whites, blacks were younger, median age 71 yrs. (IQR 62, 82) vs 79 yrs. (70, 85), more often female 56% vs 53%, and had more non-cardiovascular co-morbidities. Overall, median CHA2DS2VASc score was similar in blacks 4 (3, 6) and whites 4 (3, 5); however, among patients under age 45, blacks had a higher median CHA2DS2VASc score 3 (2, 4), than whites 2 (2, 3). Overall, unadjusted rates of OAC use were similar by race; however, OAC use was lower among blacks relative to whites ≥75 yrs. and whites relative to blacks ≤45 yrs. (Figure) Adjusting for clinical and hospital characteristics, blacks were less often prescribed OAC at discharge than whites, OR 0.90 (95% CI 0.89-0.91).Conclusions: Blacks hospitalized with AF vary from whites in demographics and prevalence of non-cv co-morbidities. Fewer than half of black and white patients received OAC at discharge, and blacks were less likely than whites to be prescribed OAC highlighting a gap in stroke preventative care.