Academic Journal
Social Determinants of Guideline-Directed Oral Anticoagulation Prescription in Patients With Atrial Fibrillation Without Contraindications: Findings From the American Heart Association Get With the Guidelines-Atrial Fibrillation Registry.
| Τίτλος: | Social Determinants of Guideline-Directed Oral Anticoagulation Prescription in Patients With Atrial Fibrillation Without Contraindications: Findings From the American Heart Association Get With the Guidelines-Atrial Fibrillation Registry. |
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| Συγγραφείς: | Osawa I; Division of Cardiology, Department of Medicine Columbia University Irving Medical Center New York NY USA., Shimada YJ; Division of Cardiology, Department of Medicine Columbia University Irving Medical Center New York NY USA. |
| Πηγή: | Journal of the American Heart Association [J Am Heart Assoc] 2026 Oct 06; Vol. 15 (19), pp. e050448. Date of Electronic Publication: 2026 Sep 24. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Oxford : Wiley-Blackwell |
| Ιατρικοί όροι (MeSH): | Atrial Fibrillation*/drug therapy , Atrial Fibrillation*/complications , Atrial Fibrillation*/diagnosis , Atrial Fibrillation*/epidemiology , Anticoagulants*/administration & dosage , Stroke*/prevention & control , Stroke*/etiology , Stroke*/epidemiology , Practice Patterns, Physicians'*/standards , Social Determinants of Health* , Guideline Adherence* , Practice Guidelines as Topic*, United States/epidemiology ; Humans ; Female ; Registries ; Male ; Aged ; Administration, Oral ; American Heart Association ; Aged, 80 and over ; Risk Factors ; Middle Aged ; Risk Assessment ; Drug Prescriptions |
| Περίληψη: | Background: Oral anticoagulant (OAC) prescriptions recommended by atrial fibrillation guidelines to prevent stroke may be influenced by social determinants of health (SDOH). We aimed to uncover patient and institutional SDOH associated with failure to prescribe guideline-directed OAC and to develop an SDOH-based scoring system to predict failure to prescribe OAC. Methods: We analyzed the nationwide, 249-hospital American Heart Association GWTG-AFib (Get With The Guidelines-Atrial Fibrillation) registry. We included adult patients hospitalized for atrial fibrillation with class I indication for OAC and no contraindications. Using a logistic regression model, we identified patient and institutional SDOH of failure to prescribe OAC, adjusting for the other SDOH. Next, we developed a machine learning-based prediction model in a training data set and examined the relative contribution of each SDOH. We then compared the risk of failure to prescribe OAC in an independent test data set for validation. Results: Among 68 628 eligible patients, 1345 (2.0%) patients did not receive guideline-directed OAC prescription. The guideline-directed OAC prescription was influenced by both institutional SDOH (eg, hospital region, hospital size, the absence of a cardiology team) and patient SDOH (eg, sex, insurance). The absence of a cardiology team was the most important predictor (adjusted odds ratio [OR], 3.72 [95% CI, 3.20-4.32]). Patients with the higher-than-Youden-index-cutoff prediction score had higher risk of failure to prescribe OAC than those with the lower-than-cutoff prediction score (OR, 3.11 [95% CI, 2.67-3.63]). Conclusions: We identified both institutional and patient SDOH of guideline-directed OAC prescription failure. We further developed and validated a SDOH-based scoring system to predict failure to prescribe OAC. |
| Contributed Indexing: | Keywords: atrial fibrillation; machine learning; oral anticoagulants; social determinants of health; stroke |
| Substance Nomenclature: | 0 (Anticoagulants) |
| Entry Date(s): | Date Created: 20260925 Date Completed: 20261008 Latest Revision: 20261008 |
| Update Code: | 20261008 |
| DOI: | 10.1161/JAHA.126.050448 |
| PMID: | 42786624 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 2047-9980 |
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| DOI: | 10.1161/JAHA.126.050448 |