Black and Hispanic older adults with atrial fibrillation were less likely to take direct oral anticoagulants (DOACs) over a 10-year span when DOACs gained popularity and prescriptions for the conventional drug warfarin waned. This reveals that disparities remained even as a new class of drugs became the first-line treatment for the heart condition, a new study published Monday in JAMA Network Open found.
Experts prefer DOACs over warfarin for stroke prevention in those with atrial fibrillation. When the study period began in 2010, warfarin was the most common anticoagulant. But the introduction of DOACs that same year changed that in all subgroups during a 10-year period, the authors pointed out. In the United States, atrial fibrillation is less common in minorities compared to white people, but minorities are less likely to be diagnosed with the condition and are more likely to be undertreated for it, the authors pointed out.
Data was derived from 950,698 people over the age of 65 from 2010 to 2019. All of them had atrial fibrillation. During the study span, 269,724 started using warfarin and 680,974 people began taking DOACs such as dabigatran, rivaroxaban, apixaban and edoxaban. The average age was 78.5 years old, and 52.6% were women. Of the participants, 5.2% were Black, 4.3% were Hispanic and 86.7% were white.
Warfarin initiations fell by 85.7 percentage points from 95.1% in 2010 to 9.4% in 2019. Warfarin initiation was more common in Black participants compared to white or Hispanic individuals, the data showed.
Compared with white people, Black individuals were 23% less likely to start DOACs, and Hispanics were 13% less likely to do the same over the course of the study. Disparities in DOAC initiation were greatest among Black patients in the earlier years but weakened during the study period. There weren’t any major disparities during the final year of the study, the data showed.
