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Abstract: FR-PO397

Racial/Ethnic Disparities in Atrial Fibrillation Treatment and Outcomes in US Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Waddy, Salina Paulette, Atlanta Veterans Administration, Decantur, Georgia, United States
  • Solomon, Allen J., The George Washington University, Washington, District of Columbia, United States
  • Becerra, Adan Z., Social & Scientific Systems, Inc., Silver Spring, Maryland, United States
  • Ward, Julia B., Social & Scientific Systems, Inc., Silver Spring, Maryland, United States
  • Chan, Kevin, National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Fwu, Chyng-Wen, Social & Scientific Systems, Inc., Silver Spring, Maryland, United States
  • Norton, Jenna M., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Eggers, Paul, National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Abbott, Kevin C., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
Background

Stroke prevention is a major goal in the management of end-stage renal disease (ESRD) dialysis patients with atrial fibrillation (AF). In the general AF population, racial/ethnic minorities have higher stroke rates, lower rates of anticoagulation and higher anticoagulation complication rates. We desribe differential treatment patterns by race/ethnicity and their association with racial/ethnic disparities in stroke outcomes among dialysis patients with AF.

Methods

We used the United States Renal Data System to identify ESRD patients diagnosed with AF who initiated hemodialysis from 2006-2013 with Medicare Part A, B, and D coverage. Patients were followed for all-cause stroke, mortality, prescription of oral medications for AF, and cardiovascular disease procedures (CVD) for AF. We used a causal inference mediation approach that accounts for time varying mediators and confounders to quantify what proportion of excess strokes can be attributed to lower use of AF therapies by race/ethnicity.

Results

The study included 56,587 ESRD dialysis patients with AF. Black, non-Hispanic White, Hispanic, and Asian patients accounted for 19%, 69%, 8%, and 3% of the population, respectively. In adjusted analyses, Black, Hispanic, and Asian patients were 13%, 18%, and 22% more likely to experience stroke within 1 year and 10%, 17%, and 28% times less likely to fill a prescription for warfarin compared to White patients, respectively. Prescription of warfarin was associated with decreased stroke rates (HR=0.82). Mediation analyses suggested that 7%, 10%, and 12% of excess strokes among Black, Hispanic, and Asian patients could be prevented if the warfarin distributions in these groups were equalized to that in the White population. We did not find racial/ethnic disparities for all-cause mortality or use of CVD procedures. All results achieved p<0.05.

Conclusion

Increased racial/ethnic disparities in stroke rates among ESRD dialysis patients with AF are partially explained by lower use of oral anticoagulants among Blacks, Hispanics, and Asians. The reasons for these racial disparities in practice are unknown, but the results support the development of strategies to maximize stroke prevention in minority populations that address patient, physician, and system barriers to optimal treatment.