First Advisor

Bory Kea

Date of Award

Spring 6-16-2024

Document Type

Thesis

Degree Name

Bachelor of Science (B.S.) in Public Health Studies: Clinical Health Sciences and University Honors

Department

OHSU-PSU School of Public Health

Language

English

Subjects

Health, Equity, Minority

Abstract

Study Objective: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and often, first diagnosed in the emergency department (ED). AF increases the risk of stroke, which can be decreased by 64% if the appropriate oral anticoagulation (OAC) is prescribed. However, many patients are not prescribed OAC for new AF. We investigate whether patient ethnicity, specifically Hispanic-Latino & Russian/Ukrainian, affects OAC prescription.

Method: This retrospective chart review study included patients at an academic tertiary care center and a community hospital >17 years old with a primary ED diagnosis of AF or paroxysmal AF from January 2020-2024. Patients with valvular heart disease or high risk for bleeding were excluded. Trained chart reviewers manually abstracted electronic health record (EHR) data. Factors that may be predictive of OAC prescription were used to assess stroke and bleeding risk, including demographics, medication, disposition, EKG, comorbidities, vital signs, and ED management. An exploratory analysis was performed to evaluate the relationship between patient ethnicity and anticoagulation prescribing rates. The relationship was then tested for statistical significance with a chi-square test.

Results: Among 629 patients that are over the age of 17 with a primary diagnosis of AF or paroxysmal AF in the ED, 5.88% (n=37) were Hispanic-Latino and 94.12% (n=592) were not. Providers prescribed or adjudicated stroke prophylaxis for 45.47% (n=286) patients, 6.29% (n=18) of which are Hispanic-Latino and 93.71% (n= 268) are non-Hispanic-Latino. 48.65% (n=18) of Hispanic-Latino patients were prescribed OAC, while 45.27% (n=268) of non-Hispanic-Latino patients were prescribed OAC. There was not a significant difference between prescribing rates in patients who are Hispanic-Latino vs non-Hispanic-Latino (p=0.69). 2.54% (n=17) of which had Russian/Ukrainian as their preferred language while 97.46% are non-Russian/Ukrainian. 43.75% (n=7) of patients with Russian/Ukrainian as their preferred language were prescribed OAC, while 45.09% (n=280) of patients with another preferred language were prescribed OAC. There was not a significant difference between prescribing rates in patients who had Russian/Ukrainian as their preferred language vs another preferred language (p=0.91).

Conclusions: Although prescribing rates were different between ethnic groups, we did not find a statistically significant difference in OAC prescribing for Hispanic-Latino patients and non-Hispanic-Latino patients, as well as Russian/Ukrainian patients and non-Russian/Ukrainian. This exploratory analysis yielded interesting results and needs further investigation to explore factors that lead to prescribing OAC, such as the unique characteristics of patients who have communication barriers with their provider and how these influence the provider's decision to prescribe OAC. It may also be worth investigating the role of unconscious biases when a provider makes the decision to prescribe for individuals from these populations.

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