Gaps in Stroke Prophylaxis Among Patients With AF

TOPLINE:

A new study revealed significant gender and age disparities in the use of oral anticoagulants (OACs) for the prevention of stroke among high-risk patients with atrial fibrillation (AF) discharged from the emergency department (ED). Although the rate of OAC use in this population improved from 2010 to 2017, it remained suboptimal.

METHODOLOGY:

• Researchers conducted a retrospective cohort study from 2010 to 2017 across 21 community medical centers in Northern California, including 9603 adult health plan members (mean age, 73.1 years; 62.3% women; 76.3% non-Hispanic White) with a primary ED diagnosis of nonvalvular AF and indications for stroke prophylaxis.
• Eligible patients were OAC-naive at ED arrival, were discharged home, had a high risk for stroke, and had a low or intermediate risk for bleeding.
• The primary outcome was stroke prevention action (OAC action) — defined as having either an OAC prescription or an anticoagulation management service consultation — within 14 days of the ED visit.

TAKEAWAY:

• OAC action rates showed significant improvement from 2010 to 2017 (increase, 16.0%; 95% CI, 12.3-19.7).
• OAC action was more likely to be received by men vs women (29.0% vs 25.5%; P < .001), patients aged 75-84 years vs those younger than 64 years (32.7% vs 22.3%; P < .001), and Hispanic White vs non-Hispanic White individuals (33.1% vs 25.8%; P < .001).
• The OAC action rate was higher among patients with a moderate risk for stroke than among those with a low risk for stroke (30.3% vs 25.4%; P < .0001). However, OAC use did not differ significantly between the high-risk and low-risk cohorts.

IN PRACTICE:

“Improved insurer coverage nationwide, as well as approval and availability of generic OAC medications, could significantly increase prescribing and affordability and, thereby, increase patient access to medications and subsequent patient adherence,” the authors wrote.

SOURCE:

The study was led by Bory Kea, MD, Oregon Health and Science University, Portland, Oregon. It was published online on May 13, 2025, in the International Journal of Emergency Medicine.

LIMITATIONS:

The study population was limited to insured health plan members within an integrated health system, reducing generalizability to broader or uninsured populations. Changes in stroke risk guidelines during the study period may have influenced prescribing patterns, particularly for women. The use of aggregated bleeding risk scores and structured data limited the ability to assess individual-level clinical decisions. The study ended in 2017, overlapping with the early adoption of direct OACs, which may not have reflected current prescribing trends.

DISCLOSURES:

This study was funded by the National Heart, Lung, and Blood Institute. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.