An analysis of ten years of UK prescribing data for atrial fibrillation has uncovered racial and socioeconomic inequalities in the use of oral anticoagulants.
Using data from more than 1,100 UK general practices, researchers at the University of Manchester, along with contributors from King Abdulaziz University in Saudi Arabia, found that between 2009 and 2019, the overall age-adjusted incidence of non-valvular atrial fibrillation increased by almost a quarter from 20.8 to 25.5 per 10,000 patients.
Over this same period, prescribing rates for oral anticoagulation rose from 59.8% to 83.2% for eligible patients.
However, compared with those who had white ethnicity, researchers found that black people were 22% less likely to be prescribed an oral anticoagulant, while those from other ethnic minorities were 24% less likely.
In addition, those living in the most deprived areas were 15% less likely to receive oral anticoagulation compared with those in the least deprived areas, the research team found.
Lower levels of oral anticoagulant prescriptions were also linked with other health conditions, including dementia, liver disease, malignancy and history of falls.
Writing in PLOS Medicine on 7 June 2022, the researchers concluded that this provided “further evidence to suggest that patients at higher risk of stroke due to their baseline comorbidities, and who are more likely to benefit from anticoagulation, are not receiving appropriate treatment”.
The researchers noted that, at practice level, “there were variations in anticoagulation prescribing relating to patient ethnicity and local area socioeconomic deprivation”, with black patients in deprived areas more likely to be prescribed aspirin only or no treatment.
“Although our findings showed that this inequality in [oral anticoagulant] prescribing between white and black patients is getting narrower over time for patients residing in the least deprived areas, it is not the same case for patients residing in the most deprived areas,” they continued, noting that after 2017 the gap in the group seems to be widening.
While the proportion of patients with atrial fibrillation receiving evidence-based anticoagulation therapy had increased over time, there are still many patients at risk of stroke who are not receiving anticoagulants, they concluded.
“Clinical and sociodemographic factors play a role in the underprescribing of [oral anticoagulants], including comorbidities such as dementia, and patient’s ethnicity and socioeconomic status.
“Addressing these inequalities through equitable interventions to improve [oral anticoagulant] prescribing could substantially improve atrial fibrillation outcomes, preventing stroke events and reducing mortality,” the researchers said.
The study’s findings follow a pharmacy-led programme to identify patients with atrial fibrillation in 2019, which NHS England suggested may have prevented up to 90 atrial fibrillation-related strokes across 23 clinical commissioning groups.