Initiation and Persistence with Warfarin Therapy in Atrial Fibrillation According to Ethnicity
The aim of this study was to investigate initiation of and persistence with warfarin treatment in patients with atrial fibrillation according to ethnicity. Patients hospitalized with first-time atrial fibrillation from 1997-2009, prescription claims of warfarin and country of birth were identified b...
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doaj-bbbf70ed296848ad8e0845b392cfca502020-11-25T00:16:02ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122012-06-01310.3389/fphar.2012.0012317970Initiation and Persistence with Warfarin Therapy in Atrial Fibrillation According to EthnicityCarolina eMalta Hansen0Jonas Bjerring Olesen1Morten Lock Hansen2Aziza eAzimi3Christian eTorp-Pedersen4Helena eDominguez5Copenhagen University Hospital Gentofte Copenhagen University Hospital Gentofte Copenhagen University Hospital Gentofte Copenhagen University Hospital Gentofte Copenhagen University Hospital Gentofte Copenhagen University Hospital HerlevThe aim of this study was to investigate initiation of and persistence with warfarin treatment in patients with atrial fibrillation according to ethnicity. Patients hospitalized with first-time atrial fibrillation from 1997-2009, prescription claims of warfarin and country of birth were identified by individual-level linkage of nationwide administrative agencies. Cox proportional hazards models were used to estimate the relationship between covariates affecting initiation and non-persistence with warfarin treatment. A total of 151,537 patients were included in the study and 5,061(3.3%) were of non-Danish origin. CHADS2 score distribution varied substantially according to ethnicity, the proportion of patients with CHADS2 score≥1 being 79.2%, 78.1%, 65.9% and 46.0% for patients of Danish, Western, Eastern and African origin, respectively. 79,239(52.4%) of all patients initiated treatment with warfarin at some point in time. Multivariable Cox proportional hazard analyses indicated patients of Eastern and African origin were less likely to initiate warfarin therapy (HR 0.75; 95% CI 0.69-0.82 and HR 0.58; 95% CI 0.44-0.76, respectively). Patients of Eastern origin were more likely to interrupt treatment (HR 1.23 95% CI 1.02-1.47; for all patients; HR 1.62 95% CI 1.22-2.16; for patients with CHADS2 score>1). African origin was associated with a trend to interrupt treatment (HR 1.44 95% CI 0.46-4.47; for patients with CHADS2 score>1). Initiation of and persistence with warfarin in atrial fibrillation patients is lower among patients of Eastern and African origin compared to patients of Danish and Western origin, despite equal access to health care and medication. Future studies should address, beyond ethnicity, all possible driving factors of (non)initiation and persistence with treatment in general. This will be particularly interesting in light of the new generation of anticoagulants, which might render different adherence to treatment.http://journal.frontiersin.org/Journal/10.3389/fphar.2012.00123/fullAtrial FibrillationWarfarinethnicityVKA treatment |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Carolina eMalta Hansen Jonas Bjerring Olesen Morten Lock Hansen Aziza eAzimi Christian eTorp-Pedersen Helena eDominguez |
spellingShingle |
Carolina eMalta Hansen Jonas Bjerring Olesen Morten Lock Hansen Aziza eAzimi Christian eTorp-Pedersen Helena eDominguez Initiation and Persistence with Warfarin Therapy in Atrial Fibrillation According to Ethnicity Frontiers in Pharmacology Atrial Fibrillation Warfarin ethnicity VKA treatment |
author_facet |
Carolina eMalta Hansen Jonas Bjerring Olesen Morten Lock Hansen Aziza eAzimi Christian eTorp-Pedersen Helena eDominguez |
author_sort |
Carolina eMalta Hansen |
title |
Initiation and Persistence with Warfarin Therapy in Atrial Fibrillation According to Ethnicity |
title_short |
Initiation and Persistence with Warfarin Therapy in Atrial Fibrillation According to Ethnicity |
title_full |
Initiation and Persistence with Warfarin Therapy in Atrial Fibrillation According to Ethnicity |
title_fullStr |
Initiation and Persistence with Warfarin Therapy in Atrial Fibrillation According to Ethnicity |
title_full_unstemmed |
Initiation and Persistence with Warfarin Therapy in Atrial Fibrillation According to Ethnicity |
title_sort |
initiation and persistence with warfarin therapy in atrial fibrillation according to ethnicity |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Pharmacology |
issn |
1663-9812 |
publishDate |
2012-06-01 |
description |
The aim of this study was to investigate initiation of and persistence with warfarin treatment in patients with atrial fibrillation according to ethnicity. Patients hospitalized with first-time atrial fibrillation from 1997-2009, prescription claims of warfarin and country of birth were identified by individual-level linkage of nationwide administrative agencies. Cox proportional hazards models were used to estimate the relationship between covariates affecting initiation and non-persistence with warfarin treatment. A total of 151,537 patients were included in the study and 5,061(3.3%) were of non-Danish origin. CHADS2 score distribution varied substantially according to ethnicity, the proportion of patients with CHADS2 score≥1 being 79.2%, 78.1%, 65.9% and 46.0% for patients of Danish, Western, Eastern and African origin, respectively. 79,239(52.4%) of all patients initiated treatment with warfarin at some point in time. Multivariable Cox proportional hazard analyses indicated patients of Eastern and African origin were less likely to initiate warfarin therapy (HR 0.75; 95% CI 0.69-0.82 and HR 0.58; 95% CI 0.44-0.76, respectively). Patients of Eastern origin were more likely to interrupt treatment (HR 1.23 95% CI 1.02-1.47; for all patients; HR 1.62 95% CI 1.22-2.16; for patients with CHADS2 score>1). African origin was associated with a trend to interrupt treatment (HR 1.44 95% CI 0.46-4.47; for patients with CHADS2 score>1). Initiation of and persistence with warfarin in atrial fibrillation patients is lower among patients of Eastern and African origin compared to patients of Danish and Western origin, despite equal access to health care and medication. Future studies should address, beyond ethnicity, all possible driving factors of (non)initiation and persistence with treatment in general. This will be particularly interesting in light of the new generation of anticoagulants, which might render different adherence to treatment. |
topic |
Atrial Fibrillation Warfarin ethnicity VKA treatment |
url |
http://journal.frontiersin.org/Journal/10.3389/fphar.2012.00123/full |
work_keys_str_mv |
AT carolinaemaltahansen initiationandpersistencewithwarfarintherapyinatrialfibrillationaccordingtoethnicity AT jonasbjerringolesen initiationandpersistencewithwarfarintherapyinatrialfibrillationaccordingtoethnicity AT mortenlockhansen initiationandpersistencewithwarfarintherapyinatrialfibrillationaccordingtoethnicity AT azizaeazimi initiationandpersistencewithwarfarintherapyinatrialfibrillationaccordingtoethnicity AT christianetorppedersen initiationandpersistencewithwarfarintherapyinatrialfibrillationaccordingtoethnicity AT helenaedominguez initiationandpersistencewithwarfarintherapyinatrialfibrillationaccordingtoethnicity |
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