Abstract 14134: Racial Disparities in Warfarin Time in INR Therapeutic Range in Patients With Atrial Fibrillation: Findings From the TREAT-AF Study
Background: The influence of race on quality of anticoagulation control is not known. We examined the association between race, time in INR therapeutic range (TTR), and INR monitoring intensity (INRMR).
Methods: The Retrospective Evaluation and Assessment of Therapies in AF (TREAT-AF) is retrospective cohort study of patients with newly-diagnosed AF treated in the U.S. Veterans Health Administration. National inpatient, outpatient, pharmacy, and claims data were used to identify patients diagnosed with new AF between 2004 and 2008 and prescribed warfarin within 90 days. Race was ascertained using demographic information from multiple VA sources and Medicare data. We examined the primary outcomes of INR monitoring rate and TTR of 2.0-3.0 using logistic and generalized linear and latent mixed regression models.
Results: In 83,161 patients on warfarin, first-year and long-term TTR for African-Americans was lower than for all other racial groups and was highest in Caucasians (Table). After adjusting for site and all patient-level covariates, African-American race was associated with a decrease in TTR by 2.9% relative to Caucasians. There was no difference by race in INR monitoring intensity, warfarin adherence (outpatient days covered with warfarin prescription), or persistence (warfarin duration before discontinuation).
Conclusion: Racial disparities in TTR are evident among African-Americans compared to other racial groups, however this is not explained by INR monitoring intensity or warfarin adherence or persistence. Whether differences could be attributable to other measures of warfarin adherence, biological differences, or other factors requires further investigation.
- © 2013 by American Heart Association, Inc.