From Pfizer, Inc., an ACOFP Corporate Council Roundtable Member
Atrial fibrillation (AF) is one of the most common types of heart arrhythmias and a growing concern in healthcare. Despite its prevalence, a troubling reality exists; significant racial disparities occur in the diagnosis, treatment, and outcomes of AF, leading to critical gaps in care that family practice physicians must address.
Understanding Disparities
Research indicates the prevalence and incidence of AF vary markedly across different racial/ethnic groups. Most studies predominantly focus on white populations, leaving a substantial knowledge gap regarding Black, Hispanic, and other underrepresented groups. For instance, a retrospective study of Medicare patients with AF newly initiated on warfarin or direct-acting oral anticoagulants (DOACs) revealed that of those receiving DOACs, only 4.8% were black and 4.2% were Hispanic, while 86.9% were white. This stark underrepresentation highlights the urgent need for equitable care strategies.
Importance of Equitable Care
To bridge these gaps, healthcare providers should prioritize four foundational strategies:
- Recognize risk factors: Understanding and addressing unique risk factors that contribute to AF in diverse populations is crucial.
- Consider screening: Screening protocols tailored to high-risk populations may lead to earlier detection and treatment.
- Evaluate treatment: Disparities in initiation of DOACs among racial groups may indicate a need to reevaluate treatment protocols.
- Assess outcomes: Regularly evaluating treatment outcomes across all racial/ethnic groups can help identify persistent disparities and inform future care strategies. This data-driven approach will enable family practice physicians to adapt their practices to better serve all patients.
Taking Action
Family practice physicians play a pivotal role in addressing disparities. Below are actionable steps physicians can take. (Note: Linked websites are neither owned nor controlled by Pfizer. Pfizer accepts no responsibility for the content or services of linked site.)
- Educate the team: Stay informed about the latest research on AF and racial disparities. Consider attending workshops or webinars focused on health equity in cardiovascular care.
Resource: ACOFP Education - Evaluate treatment options: Ensure all patients have access to guideline-recommended treatment options, including DOACs. Discuss benefits and risks of anticoagulation therapy with patients.
Resource: ACC/AHA/ACCP/HRS guidelines on AF - Implement culturally competent care: Tailor communication and treatment approaches to meet cultural needs of patients. Consider training for staff.
Resource: Explore cultural competence education from National Center for Cultural Competence. - Engage with the community: Foster relationships with community organizations to raise awareness about AF. Community outreach may help educate patients about AF and the importance of treatment adherence.
Resource: CDC National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention - Advocate for policy changes: Support initiatives that promote health equity in practice and the community. Advocacy can lead to systemic changes that may improve access to care for underrepresented populations.
Resource: Stay informed on advocacy programs through the American Public Health Association. - Regularly assess outcomes: Monitor treatment outcomes across all patients, including different racial and ethnic groups, to identify persistent disparities. Use this data to improve patient care.
Resource: Utilize National Quality Forum for guidelines on measuring health disparities.
Conclusion
The existence of racial disparities in AF can present significant challenges for family practice physicians. Understanding disparities and taking action are important ways to ensure all patients receive equitable care in order to close gaps in AF treatment and improve outcomes for all.
Sources
- Norby FL, et al. J Am Coll Cardiol. 2021;78(25):2563-2572. doi: 10.1016/j.jacc.2021.04.110.
- U.S. Food & Drug Administration. https://www.fda.gov/media/143592/download. Updated November 2020. Accessed November 2024.
- Reynolds KR, et al. JAMA Netw Open. 2024;7(5):e249465. doi:10.1001/jamanetworkopen.2024.9465.
