Area Level Deprivation and Stroke Prophylaxis for New Atrial Fibrillation in the Emergency Department

Atrial fibrillation (AF) is an arrhythmia that increases stroke risk, which can be reduced by 64% with appropriate oral anticoagulation (OAC). Many patients are first diagnosed in the emergency department (ED), where treatment decisions rely on risk scores that exclude socioeconomic factors such as the Area Deprivation Index (ADI). ADI may influence providers’ decision-making to prescribe OAC and therefore contribute to inequities in stroke prevention. We examined the relationship between ADI and OAC prescription among patients with newly diagnosed AF in the ED.

This retrospective chart review included patients >17 years with a primary ED diagnosis of AF or paroxysmal AF at an urban tertiary academic center and two community hospitals from 2020-2025. Patients with valvular disease or high bleeding risk were excluded. Demographics, comorbidities, and encounter-related outcomes were abstracted from electronic health records. ADI was linked to zip codes and grouped into tertiles. Multivariable logistic regression analyzed the association between ADI and OAC initiation, adjusting for CHA₂DS₂-VASc score, comorbidities, social history, and cardiologist recommendation.

Among 683 eligible patients, the model showed a significant association between ADI and OAC prescribing. Compared with the highest ADI tertile, patients in the lowest tertile had greater odds of receiving an OAC (OR 2.0, 95% CI 1.0-2.7). The adjusted probability of OAC prescribing for the lowest tertile was 54.7% (95% CI 47.1–62.2%), the middle was 46.2% (95% CI 41.1–51.3%), and the highest 42.8% (95% CI 35.4–50.2%). Higher stroke risk was also associated with OAC initiation; the odds of OAC prescription for patients with CHA₂DS₂-VASc >2 were greater than those with low risk (OR 2.5 95% CI 1.4–4.5). Cardiology consultation showed the strongest association with OAC prescription (OR 40.5, 95% CI 14.9–110.0).

Our findings suggest that there is an association between area-level deprivation and OAC prescription for patients with newly diagnosed AF, which may contribute to inequities in stroke prevention and warrants further study.