Atrial fibrillation (AFib) is the most common type of heart arrhythmia. Although African Americans have lower rates of AFib than do Caucasians, they have higher rates of stroke. Racial disparities exist in patients with atrial fibrillation who take Warfarin. African-American patients’ higher rates of stroke and bleeding may be explained by poor anticoagulation control. Warfarin has been a long-standing anticoagulant used in the treatment of AFib. In the African-American community, poor anticoagulation control with Warfarin is strongly associated with decreased adherence. Although adherence rates differ by race, it is unknown if racial differences in adherence remain with the newer direct oral anticoagulants. Furthermore, healthcare providers are unsure which anticoagulant agent is the best choice to optimize adherence and outcomes.
Adherence studies have focused on education and behavioral interventions but often ignore patient and provider barriers and cultural factors. Our work aims to reduce disparities by improving adherence through understanding which factors influence adherence to Warfarin and direct oral anticoagulants in African Americans with AFib. We will explore the process of medication taking, knowledge, and attitudes toward stroke, and communication patterns among patients and providers through discussion with members of the African-American community, AFib patients, their family members, healthcare providers, and other key stakeholders. This community-based team will generate research questions to advance medication adherence, health education communication, and team sustainability.