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Background <p>Non-valvular atrial fibrillation (NVAF) carries a severe risk of ischemic stroke, making anticoagulation therapy the cornerstone of prophylaxis. However, real-world data on anticoagulation management at the primary care level remain sparse. This study aims to evaluate the current landscape of anticoagulation therapy among older NVAF patients undergoing community health examinations in Shanghai, China, and to analyze the disparities between urban and suburban populations.</p> Methods <p>A stratified cross-sectional study was conducted across four community health centers (CHCs)—two urban and two suburban. The study included older participants diagnosed with AF via electrocardiogram during 2020 routine health check-ups. Anticoagulant utilization and medication-dispensing patterns were compared between the urban and suburban cohorts. Multivariable logistic regression analysis was employed to identify factors influencing medication-dispensing location preferences among NVAF patients at high risk of stroke.</p> Results <p>A total of 302 patients were included (mean age 75.3 ± 6.7 years). The prevalence of thromboembolic events and bleeding complications was 14.9% and 3.6%, respectively. Compared to the suburban cohort, urban patients were significantly older and exhibited a higher prevalence of diabetes, hyperlipidemia, carotid plaques, previous bleeding events, and high stroke risk (<i>p</i> &lt; 0.05). Among those receiving anticoagulation, 49.4% sourced their medications from CHCs. Advanced patient age and high awareness of AF-related risk emerged as independent determinants favoring community-based dispensing locations.</p> Conclusion <p>Anticoagulation management for older NVAF patients in community settings remains suboptimal. While standardized anticoagulation treatment rates for high-risk patients show no significant urban-suburban divide, targeted initiatives are essential to optimize and standardize anticoagulation protocols in this vulnerable demographic.</p>

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Disparities in anticoagulation therapy for older adults with non-valvular atrial fibrillation: a comparative study of urban and suburban communities

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月8日

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  • Yuanxia Duan,
  • Zhigang Pan,
  • Jie Gu,
  • Ying Qing,
  • Xiaojun Kuang,
  • Zhiping Jin

摘要

Background

Non-valvular atrial fibrillation (NVAF) carries a severe risk of ischemic stroke, making anticoagulation therapy the cornerstone of prophylaxis. However, real-world data on anticoagulation management at the primary care level remain sparse. This study aims to evaluate the current landscape of anticoagulation therapy among older NVAF patients undergoing community health examinations in Shanghai, China, and to analyze the disparities between urban and suburban populations.

Methods

A stratified cross-sectional study was conducted across four community health centers (CHCs)—two urban and two suburban. The study included older participants diagnosed with AF via electrocardiogram during 2020 routine health check-ups. Anticoagulant utilization and medication-dispensing patterns were compared between the urban and suburban cohorts. Multivariable logistic regression analysis was employed to identify factors influencing medication-dispensing location preferences among NVAF patients at high risk of stroke.

Results

A total of 302 patients were included (mean age 75.3 ± 6.7 years). The prevalence of thromboembolic events and bleeding complications was 14.9% and 3.6%, respectively. Compared to the suburban cohort, urban patients were significantly older and exhibited a higher prevalence of diabetes, hyperlipidemia, carotid plaques, previous bleeding events, and high stroke risk (p < 0.05). Among those receiving anticoagulation, 49.4% sourced their medications from CHCs. Advanced patient age and high awareness of AF-related risk emerged as independent determinants favoring community-based dispensing locations.

Conclusion

Anticoagulation management for older NVAF patients in community settings remains suboptimal. While standardized anticoagulation treatment rates for high-risk patients show no significant urban-suburban divide, targeted initiatives are essential to optimize and standardize anticoagulation protocols in this vulnerable demographic.