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

> **NIH VA IK2** · VETERANS HEALTH ADMINISTRATION · 2021 · —

## Abstract

Background. Atrial fibrillation (AF) is a common cardiac arrhythmia, affecting up to 1 million Veterans. AF
increases the risk of stroke by 5-fold and is associated with higher rates of death. Oral anticoagulation reduces
the risk of stroke in AF by 60%, yet such therapy is underutilized. Further, racial and ethnic disparities in
anticoagulation for AF exist, despite a 2-fold higher risk of stroke among racial and ethnic minorities with this
condition. In pilot work conducted in >40,000 Veterans with newly diagnosed AF in FY 2017, black Veterans
were significantly less likely than white Veterans to receive any form of anticoagulant, particularly safer, more
effective therapy with direct-acting oral anticoagulants. In these analyses there was up to 2.5-fold facility-level
variation in the frequency of anticoagulation and in racial and ethnic disparities in such therapy. With the
detection of these treatment disparities documented in VA, this CDA-2 will quantitatively assess the multilevel
determinants of these disparities, qualitatively identify barriers to and facilitators of equitable anticoagulation for
AF, and use these findings to develop and pilot test implementation strategies to eliminate these disparities.
Significance / Impact. Ensuring access to high-quality, equitable care for all Veterans are VA and VA HSR&D
priority areas. This CDA-2 addresses underuse of an evidence-based therapy for racial and ethnic minority
Veterans with AF—a common and costly condition. The significance of this problem is likely to increase with
the aging of the Veteran population and the steadily increasing proportion of minority Veterans receiving health
care within VA. Innovation. This CDA-2 is framed using blended health equity and implementation science
conceptual models to understand and reduce racial and ethnic disparities in health care. This CDA-2 uses
novel data sources to assess the association of underexamined determinants of racial and ethnic disparities in
Veterans with AF and is among the first to qualitatively examine Veteran experiences with AF and
anticoagulation. Finally, this research will be the first to develop and test implementation strategies to reduce
disparities in anticoagulation for AF. Specific Aims. Aim 1 is a quantitative study to characterize the
association between race, ethnicity, and oral anticoagulant initiation in Veterans with AF. Aim 2 is a qualitative
study to examine stakeholder perceptions of the barriers to and facilitators of equitable oral anticoagulant
initiation in Veterans with AF. Aim 3 proposes to design and pilot test an empirically-developed implementation
strategy bundle to improve equitable oral anticoagulant initiation in Veterans with AF. Methodology. Aim 1
uses a national cohort of ~130,000 Veterans with incident AF in FYs 2010-2019 to assess the patient, provider,
and facility-level determinants of the association of race, ethnicity and anticoagulation. Aim 2 will recruit and
interview providers, adminis...

## Key facts

- **NIH application ID:** 10068044
- **Project number:** 1IK2HX003176-01
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Utibe R. Essien
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-02-01 → 2026-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10068044

## Citation

> US National Institutes of Health, RePORTER application 10068044, Access, Quality and Equity of Anticoagulants in Veterans with Atrial Fibrillation (1IK2HX003176-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10068044. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*