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 Beyond, Journal of the American College of Cardiology, November 9, 2021
From: Sex differences in atrial fibrillation: patient-reported outcomes and the persistent toll on women, American 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 System, JAMA Network Open, July 28, 2021
Association Between Neighborhood-Level Poverty and Incident Atrial Fibrillation: a Retrospective Cohort Study, Journal of General Internal Medicine, July 8, 2021
From: Social determinants of atrial fibrillation, Nature Reviews Cardiology, June 2, 2021
From: Association of income and educational attainment in hospitalization events in atrial fibrillation, American Journal of Preventive Cardiology, June 1, 2021