Race, Ethnicity, and Language Concordance Between Patients and Physicians and Atrial Fibrillation DOAC Treatment

Importance While direct oral anticoagulants (DOACs) are recommended for treatment of patients with nonvalvular atrial fibrillation (NVAF) to reduce risk of mortality and stroke, studies have documented racial and ethnic disparities in DOAC use. Objective To evaluate the associations between patient-physician race, ethnicity, and language concordance and DOAC treatment initiation and persistence. Design, Setting, and Participants This retrospective cohort study was conducted using Kaiser Permanente Southern California electronic health records from January 1, 2012, through December 31, 2022. Adults 18 years of age or older with a confirmed diagnosis of NVAF and a CHA 2 DS 2 -VASc (congestive heart failure; hypertension; age ≥75 years; diabetes; prior stroke, transient ischemic attack, or thromboembolism; vascular disease; age 65-74 years; and sex category) score of 2 or higher were followed up from their first NVAF diagnosis to 60 days for a DOAC prescription order or from the first DOAC prescription fill to 1 year. Analysis was performed between April 2024 and January 2026. Exposures Patient-physician race, ethnicity, and language concordance. Main Outcomes and Measures Associations of patient-physician race, ethnicity, and language concordance with DOAC therapy initiation (defined as the receipt of a DOAC prescription within 60 days from an initial NVAF diagnosis) and persistence (defined as 1 year of continuous DOAC prescription fills without a gap of 60 or more days) were determined using multivariable logistic regression models, accounting for age, sex, patient race and ethnicity, health insurance type, and neighborhood deprivation index. Results Of 59 340 DOAC therapy–eligible patients (mean [SD] age, 76.9 [9.1] years; 32 889 [55.4%] females; 12 440 [21.0%] Hispanic, 4803 [8.1%] non-Hispanic Asian, 5374 [9.1%] non-Hispanic Black, and 35 645 [60.1%] non-Hispanic White), 34 281 (57.8%) had a DOAC prescription order. Patient-physician race and ethnicity concordance was associated with increased odds of DOAC therapy initiation (odds ratio [OR], 1.19 [95% CI, 1.14-1.24]). Among 34 215 patients with a DOAC prescription fill, 45.3% were persistent with DOAC therapy for 1 year. Both patient-physician race and ethnicity (OR, 1.08 [95% CI, 1.03-1.14]) and language (OR, 1.14 [95% CI, 1.04-1.24]) concordance were associated with increased odds of DOAC therapy persistence. Among Hispanic patients, patient-physician race and ethnicity concordance (OR, 1.39 [95% CI, 1.22-1.58]) was associated with increased odds of DOAC therapy initiation, and language concordance (OR, 1.12 [95% CI, 1.01-1.24]) was associated with increased odds of DOAC therapy persistence. Neither patient-physician race and ethnicity (OR, 1.04 [95% CI, 0.78-1.39] for initiation; OR, 1.03 [95% CI, 0.72-1.47] for persistence) nor language (OR, 0.61 [95% CI, 0.24-1.55] for initiation; OR, 1.62 [95% CI, 0.53-4.93] for persistence) concordance was associated with DOAC therapy initiation or persistence among non-Hispanic Black patients. Conclusions and Relevance In this cohort study, patient-physician race and ethnicity concordance was associated with increased odds of DOAC therapy initiation, whereas race, ethnicity, and language concordance were associated with increased odds of DOAC therapy persistence. These findings suggest patient-physician concordance as a potential pathway to support more equitable anticoagulation care.