Initiation and Persistence with Warfarin Therapy in Atrial Fibrillation According to Ethnicity

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 (AF) according to ethnicity. Patients hospitalized with first-time AF from 1997 to 2009, prescription claims of warfarin and country of birth were identified by individ...

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Main Authors: Hansen, Carolina Malta, Olesen, Jonas Bjerring, Hansen, Morten Lock, Azimi, Aziza, Torp-Pedersen, Christian, Dominguez, Helena
Format: Online
Language:English
Published: Frontiers Research Foundation 2012
Online Access:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385210/
id pubmed-3385210
recordtype oai_dc
spelling pubmed-33852102012-07-02 Initiation and Persistence with Warfarin Therapy in Atrial Fibrillation According to Ethnicity Hansen, Carolina Malta Olesen, Jonas Bjerring Hansen, Morten Lock Azimi, Aziza Torp-Pedersen, Christian Dominguez, Helena Pharmacology The aim of this study was to investigate initiation of and persistence with warfarin treatment in patients with atrial fibrillation (AF) according to ethnicity. Patients hospitalized with first-time AF from 1997 to 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 AF 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. Frontiers Research Foundation 2012-06-28 /pmc/articles/PMC3385210/ /pubmed/22754529 http://dx.doi.org/10.3389/fphar.2012.00123 Text en Copyright © 2012 Hansen, Olesen, Hansen, Azimi, Torp-Pedersen and Dominguez. http://www.frontiersin.org/licenseagreement This is an open-access article distributed under the terms of the Creative Commons Attribution Non Commercial License, which permits non-commercial use, distribution, and reproduction in other forums, provided the original authors and source are credited.
repository_type Open Access Journal
institution_category Foreign Institution
institution US National Center for Biotechnology Information
building NCBI PubMed
collection Online Access
language English
format Online
author Hansen, Carolina Malta
Olesen, Jonas Bjerring
Hansen, Morten Lock
Azimi, Aziza
Torp-Pedersen, Christian
Dominguez, Helena
spellingShingle Hansen, Carolina Malta
Olesen, Jonas Bjerring
Hansen, Morten Lock
Azimi, Aziza
Torp-Pedersen, Christian
Dominguez, Helena
Initiation and Persistence with Warfarin Therapy in Atrial Fibrillation According to Ethnicity
author_facet Hansen, Carolina Malta
Olesen, Jonas Bjerring
Hansen, Morten Lock
Azimi, Aziza
Torp-Pedersen, Christian
Dominguez, Helena
author_sort Hansen, Carolina Malta
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
description The aim of this study was to investigate initiation of and persistence with warfarin treatment in patients with atrial fibrillation (AF) according to ethnicity. Patients hospitalized with first-time AF from 1997 to 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 AF 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.
publisher Frontiers Research Foundation
publishDate 2012
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385210/
_version_ 1611539715407740928

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