Perspective:

OAC use is critical for the prevention of stroke and systemic embolism in patients with AF. Over the past decade, DOAC therapy has become first-line given their ease of use and lower rate of severe bleeding (especially intracranial hemorrhage). Within the context of a nationwide quality improvement initiative (GWTG-AFIB), the authors demonstrate that important racial and ethnic disparities exist in three key measures of AF quality. First, the overall use of any OAC was lowest among Black patients as compared to their White counterparts. Second, use of DOAC therapy was also lowest among Black as compared to White patients. Third, the risk of bleeding, stroke, and mortality were all higher among Black as compared to White patients. Hispanic patients were also at higher risk of stroke as compared to White patients. These data, within the context of a concerted quality improvement effort, demonstrate that dedicated interventions are needed to achieve pharmacoequity. While the high rate of OAC use generally is laudable, further work is needed to address issues of health system institutional racism (e.g., educational materials available only in English language, availability of specialists), clinician implicit bias (e.g., likelihood of offering DOAC vs. warfarin based on race/ethnicity), and medication cost.