Facility-Level Variation in Racial Disparities in Anticoagulation for Atrial Fibrillation: The REACH-AF Study.

Area of Science:

• Cardiology
• Health Services Research
• Health Equity

Background:

• Oral anticoagulation is crucial for reducing stroke risk in patients with atrial fibrillation (AF).
• Previous research indicates lower anticoagulant prescribing rates in Black individuals compared to White individuals.
• Limited studies have explored racial differences in anticoagulant prescribing at the facility level for AF patients.

Purpose of the Study:

• To evaluate variations in anticoagulant initiation based on race within Veterans Health Administration (VA) facilities.
• To identify potential racial disparities in the initiation of anticoagulant therapy for AF patients across different VA facilities.

Main Methods:

• Retrospective cohort study design.
• Inclusion of Black and White patients diagnosed with incident AF between 2020 and 2021 within the VA system.
• Primary outcome: Rate of any anticoagulant (warfarin or direct oral anticoagulant [DOAC]) or DOAC therapy initiation within 90 days of AF diagnosis, analyzed overall and by race within each facility. Adjusted Black-White risk differences were estimated.

Main Results:

• Analysis included 26,832 Black and White patients across 82 VA facilities.
• Significant facility-level variation was observed in unadjusted rates for both any anticoagulant (56.8%–87.1%) and DOAC therapy (55.1%–85.5%).
• Adjusted risk differences between Black and White patients varied across facilities, with some facilities showing statistically higher prescribing rates for White patients for both any anticoagulant and DOAC therapy.

Conclusions:

• A national cohort of AF patients within the VA system demonstrated substantial facility-level variability in anticoagulant and DOAC initiation.
• Significant adjusted racial risk differences in therapy initiation were identified, underscoring disparities in care.
• These findings highlight specific targets for local quality improvement initiatives aimed at enhancing AF care equity.