Managing stroke risk in patients with atrial fibrillation: a cross-sectional analysis of socio-demographic inequalities in a London borough. (14th February 2022)

• Record Type: Journal Article
• Authors: Wou, Constance; Crompton, James; Ashworth, Mark; Williams, Helen; Dodhia, Hiten
• Is Part Of: Journal of public health. Volume 44:Number 2(2022)
• Page Start: e241
• Page End: e248
• Publication Date: 2022-02-14
• Subjects: atrial fibrillation -- stroke prevention -- inequalities -- anticoagulation -- circulatory disease -- primary care; Public health -- Periodicals; Public health -- Great Britain -- Periodicals; Medical policy -- Periodicals; Medical policy -- Great Britain -- Periodicals; 362.1
• DOI: 10.1093/pubmed/fdac004
• Languages: English
• ISSNs: 1741-3842

Abstract

Abstract: Background: Stroke prevention is essential for patients with atrial fibrillation (AF), but some receive sub-optimal management. We reviewed those with a recorded AF diagnosis assessed with CHA2DS2-VASc stroke risk score (SRS) and socio-demographic determinants of anticoagulation prescribing. The objective was to compare with national guidance recommendations, which recommend anticoagulant therapy for SRS ≥ 2, to determine if there were inequalities in management. Methods: A cross-sectional design was used to analyze records from all ( n = 41) general practices in one London borough. Patients were excluded if they were <18 years, had AF resolved or diagnosed < 3 months. Logistic regression identified socio-demographic factors associated with high SRS and anticoagulant prescribing. Results: Of 2913 patients, 2885 (99.0%) had an SRS, and 2411 (83.6%) a score ≥ 2 and 82.9% (1999 of 2411) were prescribed anticoagulation. Women (compared with men), Black and Mixed/Multiple ethnic groups (compared with White), and those living in most deprived areas (compared with least) were more likely to have a score ≥ 2. Patients with a high SRS from Black and Mixed/Multiple ethnic groups and aged 18–74 years were less likely to be prescribed anticoagulation. Conclusion: We found evidence of age and ethnic inequity in anticoagulation prescribing for stroke prevention in patients with AF.