Access, Quality and Equity of Anticoagulants in Veterans with Atrial Fibrillation

Access, Quality and Equity of Anticoagulants in Veterans with Atrial Fibrillation

PI: Utibe Essien, MD, MPH
Funding Source: VA
February 2021 - January 2026

Atrial fibrillation (AF) is an increasingly common heart rhythm disorder, affecting nearly 1 million Veterans engaged in VA health care. AF is associated with an increased risk of stroke, heart failure, and hospitalization, and results in substantial medical and societal costs. Although oral anticoagulant therapy reduces the risk of stroke from AF by 60%, it is often underutilized, particularly for racial and ethnic minorities who have an even higher risk of this adverse outcome. These inequities are particularly pronounced for a newer class of direct oral anticoagulants (DOACs) – which have greater effectiveness, safety, and adherence compared to traditional warfarin anticoagulation. This project will use quantitative and qualitative research to understand the multilevel determinants of racial and ethnic disparities in anticoagulant therapy initiation for Veterans with AF and use the findings to empirically develop and test implementation strategies to reduce or eliminate these well-documented disparities.

Read published results from and related to this work
Racial and Ethnic Representation in Atrial Fibrillation Trials: CABANA and BeyondJournal of the American College of Cardiology, November 9, 2021

From: Sex differences in atrial fibrillation: patient-reported outcomes and the persistent toll on womenAmerican Journal of Preventive Cardiology, September 3, 2021

From: Disparities in Anticoagulant Therapy Initiation for Incident Atrial Fibrillation by Race/Ethnicity Among Patients in the Veterans Health Administration SystemJAMA Network Open, July 28, 2021

Association Between Neighborhood-Level Poverty and Incident Atrial Fibrillation: a Retrospective Cohort StudyJournal of General Internal Medicine, July 8, 2021

From: Social determinants of atrial fibrillationNature Reviews Cardiology, June 2, 2021

From: Association of income and educational attainment in hospitalization events in atrial fibrillationAmerican Journal of Preventive Cardiology, June 1, 2021