• Utibe R Essien, Nadejda Kim, HausmannLeslie R MLRMCenter for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Donna L Washington, Maria K Mor, Walid F Gellad, and Michael J Fine.
• HSRD Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA. utibe.essien@va.gov.
• J Gen Intern Med. 2024 May 1; 39 (7): 112211261122-1126.

BackgroundOral anticoagulation reduces stroke risk for patients with atrial fibrillation (AF). Prior research demonstrates lower anticoagulant prescribing in Black than in White individuals but few studies have examined racial differences in facility-level anticoagulant prescribing for AF.ObjectiveTo assess variation in anticoagulant initiation by race within Veterans Health Administration (VA) facilities.DesignRetrospective cohort study.ParticipantsBlack and White patients enrolled in the VA with incident AF from 2020 through 2021.Main MeasuresThe primary outcome was rate of any anticoagulant initiation (i.e., warfarin or direct oral anticoagulant [DOAC]) or any DOAC therapy within 90 days of an AF diagnosis, overall and for Black and White patients at each facility. We also estimated the adjusted Black-White risk difference.Key ResultsIn 82 VA facilities serving 26,832 Black and White patients, overall unadjusted rates of any anticoagulant therapy ranged from 56.8 to 87.1% across facilities; the corresponding ranges for Black and White patients were 47.6 to 91.3% and 58.2 to 87.1%, respectively. Overall unadjusted rates of DOAC therapy ranged from 55.1 to 85.5% by facility; ranges for Black and White patients were 42.8 to 86.9% and 56.4 to 85.5%, respectively. The adjusted risk difference between Black and White patients ranged from - 29.9 (95% CI, - 54.9 to - 4.8) to 14.2 (95% CI, - 9.1 to 25.0) across facilities for any anticoagulant therapy and from - 28.8 (95% CI, - 58.3 to 0.8) to 15.0 (95% CI, - 8.0 to 38.1) for DOAC therapy. For any anticoagulant therapy there were 3 facilities where prescribing was statistically higher in White than Black patients; for DOAC therapy there were 5 such facilities.ConclusionsIn a national cohort of patients with AF, we observed large facility-level variation and adjusted risk differences in any anticoagulant and DOAC initiation, overall and by race. These findings represent a target for local quality improvement in AF care.© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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