Impact of Social Determinants of Health on Primary Adherence of Oral Anticoagulants Among Patients with Newly Diagnosed Atrial Fibrillation.
IF 3
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
引用次数: 0
Abstract
Introduction: Oral anticoagulants (OAC) reduce the risk of stroke among patients with atrial fibrillation (AF). However, adherence remains suboptimal. We focused on primary nonadherence to OAC and its associations with patient characteristics-specifically social determinants of health collected in electronic health records (EHR).
Methods: This retrospective cohort study used EHR data linked to prescription fill data from a large, integrated Midwestern community healthcare system. Adult patients with an incident AF diagnosis from 2020 to 2021 and a first OAC prescription (index visit) were included. Primary nonadherence was defined as failure to fill an initial OAC prescription within 30 days. Outcomes included 1-year all-cause mortality, first stroke, and first bleed after first OAC prescription. Multivariable logistic regression models evaluated the likelihood of primary nonadherence, and multivariable Cox proportional hazard models evaluated the association between primary nonadherence with outcomes.
Results: Among 8679 patients, 46% were female, 82% were non-Hispanic white, and the mean age was 71.3 ± 12.1 years. Twenty-one percent were primary nonadherent. The odds of primary nonadherence were greater among patients who were non-Hispanic Black, older (≥ 75 years), male, lacking commercial insurance, not employed/retired, and referred to social work; similar results were observed for secondary nonadherence. Primary nonadherence was associated with an increased risk of all-cause mortality (hazard ratio, 1.69; 95% confidence interval, 1.42-2.01).
Conclusion: These results reveal disparities in primary nonadherence among patients with a new AF diagnosis. There is a need to develop and test interventions for primary nonadherence that are implemented in disadvantaged patients, among whom nonadherence is highest.
社会健康因素对初诊房颤患者口服抗凝药物依从性的影响
简介：口服抗凝药（OAC）可降低心房颤动（AF）患者的中风风险。然而，患者的依从性仍不理想。我们重点研究了 OAC 的主要不依从性及其与患者特征的关系，特别是电子健康记录（EHR）中收集的健康社会决定因素：这项回顾性队列研究使用了与中西部大型综合社区医疗系统处方填写数据相关联的电子病历数据。研究纳入了 2020 年至 2021 年期间被诊断为房颤且首次开具 OAC 处方（指标就诊）的成年患者。主要不依从性定义为未能在 30 天内开具首次 OAC 处方。结果包括 1 年全因死亡率、首次中风和首次 OAC 处方后的首次出血。多变量逻辑回归模型评估了初次不依从的可能性，多变量 Cox 比例危险模型评估了初次不依从与结果之间的关联：在 8679 名患者中，46% 为女性，82% 为非西班牙裔白人，平均年龄为 71.3 ± 12.1 岁。21%的患者为初次不依从。在非西班牙裔黑人、年龄较大（≥ 75 岁）、男性、无商业保险、未就业/退休和转诊至社会工作的患者中，初次不坚持治疗的几率更大；在二次不坚持治疗的患者中也观察到类似的结果。初级不依从与全因死亡风险增加有关（危险比为 1.69；95% 置信区间为 1.42-2.01）：这些结果揭示了新诊断为房颤的患者在初次不坚持治疗方面存在的差异。有必要开发和测试针对初级不依从症的干预措施，并在弱势患者中实施，因为这些患者的不依从症最为严重。
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来源期刊
Cardiology and Therapy
CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
5.30
自引率
0.00%
发文量
38
审稿时长
6 weeks
期刊介绍：
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Cardiology and Therapy is an international, open access, peer reviewed (single-blind), rapid-publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of cardiovascular therapies and interventions, including devices. Studies relating to diagnosis and diagnostics, pharmacoeconomics, public health, quality of life, as well as patient care, management and education are also encouraged.
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