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AF Medication Selection and Disparities

CE / CME

Atrial Fibrillation Case Considerations: Medication Selection in the Face of Health Disparities

Physician Assistants/Physician Associates: 0.50 AAPA Category 1 CME credit

Nurses: 0.50 Nursing contact hour

Physicians: maximum of 0.50 AMA PRA Category 1 Credit™

Released: January 05, 2024

Expiration: January 04, 2025

David S. Kountz
David S. Kountz, MD, MBA, MACP
CME/CE Information

Activity

Progress
1 2
Course Completed

History 
Mr. Ohtani, a 54-year-old male, presents to his primary care provider as a new patient for hospital follow-up. He was hospitalized last week for shortness of breath and was diagnosed with heart failure (left ventricular ejection fraction 55%), hypertension (blood pressure 156/92 mm Hg), and AF (CHA2DS2-VASc of 2). He recently moved to the United States and has been working in construction as the sole provider for his family who live in Japan. He states that he was given several prescriptions upon discharge but could fill only furosemide until he is paid again. He is ineligible for Medicaid and is paying for his medications out of pocket.

Current Presentation 
The patient states that he has been doing well since discharge. He reports taking furosemide 20 mg once daily in the morning. His diet is variable and depends on what is within his budget at the local grocery store. He tries to eat vegetables as frequently as possible, but he usually skips at least 1 meal per day. He has many concerns about his health and wants to take good care of himself but is worried about how he will be able to afford the medicines prescribed to him. He also states that he was prescribed a “blood thinner” for his “funny heartbeat.” He mentions that his grandmother took a blood thinner but had a fall and wound up in the hospital for several weeks due to bleeding. He is unsure if he would be willing to take a similar medication even if it were affordable. 

His current blood pressure is 148/90 mm Hg; pulse 120 beats/min, currently in AF; height 6 ft, 2 in; weight 85 kg; BMI 23.1 kg/m2. Recent labs show a SCr of 0.9 mg/dL and a CrCl of 108 mL/min. All other labs are within normal limits. He is uninsured, lives alone, and has no steady income.

Question 1

You want to initiate Mr. Ohtani on anticoagulation therapy as soon as possible to prevent a stroke. How would you address Mr. Ohtani’s concerns regarding taking an anticoagulant?