Disparities in Anticoagulant Therapy Initiation for Incident Atrial Fibrillation by Race/Ethnicity among Patients in the Veterans Health Administration System

Abstract

Importance: Atrial fibrillation is a common cardiac rhythm disturbance causing substantial morbidity and mortality that disproportionately affects racial/ethnic minority groups. Anticoagulation reduces stroke risk in atrial fibrillation, yet studies show it is underprescribed in racial/ethnic minority patients. Objective: To compare initiation of anticoagulant therapy by race/ethnicity for patients in the Veterans Health Administration (VA) system with atrial fibrillation. Design, Setting, and Participants: This retrospective cohort study included 111666 patients within the VA system with incident atrial fibrillation between January 1, 2014, and December 31, 2018. Data were analyzed between December 1, 2019, and March 31, 2020. Exposures: Any anticoagulation was defined as receipt of warfarin or direct-acting oral anticoagulants, apixaban, dabigatran, edoxaban, or rivaroxaban. Main Outcomes and Measures: Initiation of any anticoagulation (or direct-acting oral anticoagulant therapy in those who initiated any anticoagulation) was examined within 90 days of an index atrial fibrillation diagnosis. Results: Our final cohort comprised 111666 patients (109386 men [98.0%] and 95493 White patients [85.5%]; mean [SD] age, 72.9 [10.4] years). A total of 69590 patients (62.3%) initiated any anticoagulant therapy, varying 10.5 percentage points by race/ethnicity (P