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Improved Oral Anticoagulants Use May be Key to Stroke Reduction Among Black Patients with Atrial Fibrillation

Oral anticoagulant

Improved use of oral anticoagulants may be a key contributor to reduce racial disparities among Black patients with atrial fibrillation (AFib) and increased rates of ischemic stroke, according to Duke electrophysiologist and researcher Larry R. Jackson, II, MD, MHSc.

The research premise was developed by Jackson while a cardiovascular medicine research fellow at the Duke Clinical Research Institute (DCRI). Key career development grants from the American Heart Association and the National Institute of Health’s National Heart, Lung, and Blood Institute support the ongoing investigation.

The finding that Black patients with atrial fibrillation are less likely to utilize oral anticoagulants for stroke reduction, Jackson says, shifted his focus toward identifying barriers that prevent utilization of stroke reduction therapies in racial and ethnic minoritized populations with AFib. Jackson’s research goal is to create interventions to remediate racial and ethnic differences in the utilization of stroke reduction therapies for AFib management. 

Larry R. Jackson II, MD
Approximately 20 to 25% of all ischemic strokes in the United States are due to AFib.
Larry R. Jackson, II, MD, MHSc.

Jackson is analyzing the determinants and barriers that prevent Black patients from utilizing contemporary stroke reduction therapies. “Are there gaps in health knowledge or literacy among Black populations that we do not understand?” Jackson asks. “Are there potential factors among clinicians and health systems that lead to decreased utilization of stroke reduction therapies including oral anticoagulants? We don’t know those answers yet.”

The condition currently affects six million people in the U.S., which he describes as a conservative estimate. The prevalence of AFib is projected to increase by more than half by 2050. “We know that the rise of AFib has the potential to dramatically increase ischemic stroke rates at an exponential rate.”

Black patients with atrial fibrillation are one of several groups that Jackson describes as having a higher burden of classic risk factors associated with AFib, but a lower incidence and prevalence of the condition. This has been called the “atrial fibrillation paradox.” 

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Core emphasis of the research

To better understanding determinants and drivers of racial and ethnic differences in stroke reduction therapies, Jackson focuses on qualitative research methodology, which includes in-depth, structured interviews and surveys.

“Health equity means that individuals can attain their full potential for health and well-being,” Jackson says. “Health equity is achieved by considering an individual’s background, social determinants of health, health behaviors, race, and ethnicity in promoting health and well-being.”