• Rasha Khatib, Nicole Glowacki, John Byrne, and Peter Brady.
• Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL.
• Medicine (Baltimore). 2022 Sep 2; 101 (35): e29997.

BackgroundA growing body of literature now exists examining associations between social determinants of health (SDOH) and adverse outcomes in patients with atrial fibrillation; however, little is available on anticoagulant prescriptions and the impact of SDOH.PurposeEvaluate the impact of SDOH on anticoagulant prescriptions in patients with atrial fibrillation.Data SourcesMedline and Embase databases up to January 2021.Study SelectionNoninterventional studies were included if they reported associations between at least 1 of 14 SDOH domains and anticoagulant prescription in patients with atrial fibrillation. Two investigators independently screened and collected data.Data ExtractionTwo investigators independently screened and collected data.Data SynthesisMeta-analyses using random-effect models evaluated associations between SDOH and receiving an anticoagulant prescription. We included 13 studies, 11 of which were included in meta-analyses that reported on the impact of 9 of the 14 SDOH included in the search. Pooled estimates indicate a 0.85 (95% confidence interval [CI]: 0.75, 0.97) lower odds of receiving anticoagulant prescriptions among Black compared to non-Black patients (reported in 6 studies); 0.42 (95% CI: 0.32, 0.55) lower odds of receiving anticoagulant prescriptions among patients with mental illness compared to those without mental illness (2 studies); and a 0.64 (95% CI: 0.42, 0.96) lower likelihood of receiving oral anticoagulant prescription among employed patients compared to unemployed patients (2 studies).LimitationsSDOH lack consistent definitions and measures within the electronic health record.ConclusionThe literature reports on only half of the SDOH domains we searched for, indicating that many SDOH are not routinely assessed. Second, social needs impact the decision to prescribe anticoagulants, confirming the need to screen for and address social needs in the clinical setting to support clinicians in providing guideline concordant care to their patients.RegistrationThis systematic review and meta-analysis was registered with PROSPERO.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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