What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=4994). Intervention: Older age (per decade) vs. Younger age. Primary outcome: Likelihood of receiving oral anticoagulants relative to neither anticoagulant nor aspirin use (RRR 0.79, 95% CI 0.71-0.87).

What does this research mean for the field?

Following the 2014 ACC/AHA guidelines, oral anticoagulant use among VA nursing home residents with atrial fibrillation increased to 46.6% by 2019, though older age, minority race/ethnicity, and cognitive impairment remain significant predictors of underuse. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the prevalence and predictors of oral anticoagulant and aspirin use among veterans with atrial fibrillation residing in Veterans Affairs long-term care facilities following the 2014 ACC/AHA guidelines.

August 28, 2026Journal of the American Medical Directors AssociationOpen Access

OAC use for AF in VA nursing homes reached ~47%, though age and racial disparities persist.

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Why the study?

Following the 2014 ACC/AHA guideline shift from aspirin to oral anticoagulants for AF stroke prevention, the prevalence and predictors of OAC and aspirin use among veterans in VA nursing homes were unknown.

What are the prevalence and predictors of oral anticoagulant use among veterans with atrial fibrillation in VA nursing homes after the 2014 ACC/AHA guideline?

Comparison

OAC ± aspirin vs aspirin alone vs neither

Design

Observational study

Key result

OAC use among VA nursing home residents with AF increased to 46.6% in 2019, though older age (RRR 0.79 per decade; 95% CI 0.71-0.87) and minority race/ethnicity predicted lower likelihood of use.

Authors

VMVeena Manja YLYongmei Li MSMichael A. Steinman

Discussion

Member takes

Overview

OAC underuse persists in VA nursing home residents with AF post-2014 guidelines; leaves open implementation barriers and optimal strategies in frail elderly.

Key Points

To evaluate the prevalence and predictors of oral anticoagulant and aspirin use among veterans with atrial fibrillation residing in Veterans Affairs long-term care facilities following the 2014 ACC/AHA guidelines.
Conducted an observational study of 4,994 Veterans Affairs nursing home residents with atrial fibrillation and a CHA2DS2-VASc score ≥2 admitted between October 1, 2014, and September 30, 2019.
Used multinomial logistic regression to identify demographic, functional, and clinical factors associated with receiving oral anticoagulants (with or without aspirin) or aspirin alone compared with neither therapy.
Age-standardized prevalence of any oral anticoagulant use increased from 31.2% in FY 2013–2014 to 46.6% in FY 2019, while aspirin monotherapy decreased from 47.7% to 39.3% and non-treatment decreased from 21.1% to 16.2%.
Older age per decade (RRR, 0.79; 95% CI, 0.71–0.87), Black race (RRR, 0.73; 95% CI, 0.58–0.91), and Hispanic ethnicity (RRR, 0.63; 95% CI, 0.44–0.91) were significantly associated with lower likelihood of receiving oral anticoagulants relative to neither therapy.
Cognitive impairment, greater disability, and concurrent non-aspirin antiplatelet use were also associated with significantly lower oral anticoagulant prescribing rates.

Study Design

Type

Observational (n=4,994)

Multicenter

Yes

Structured PICO

What are the prevalence and predictors of oral anticoagulant use among veterans with atrial fibrillation in VA nursing homes after the 2014 ACC/AHA guideline?

Population

4,994 Veterans Affairs nursing home residents with atrial fibrillation and a CHA2DS2-VASc score of ≥2, admitted between October 2014 and September 2019.

Exposure

Oral anticoagulants (OACs) ± aspirin or aspirin alone

Comparator

Neither anticoagulant nor aspirin use

Outcome

Prevalence and predictors of OACs and/or aspirin use

Main Result

Relative Risk: 0.79 (95% CI 0.71–0.87)

Despite increases in OAC use following the 2014 ACC/AHA guidelines, significant underuse remains among VA nursing home residents with AF, particularly in older, Black, and Hispanic veterans.

Cite This Study

Manja et al. (2026) conducted an observational in Atrial fibrillation (n=4,994). Older age (per decade) vs. Younger age was evaluated on Likelihood of receiving oral anticoagulants relative to neither anticoagulant nor aspirin use (RRR 0.79, 95% CI 0.71-0.87). OAC use among VA nursing home residents with AF increased to 46.6% in 2019, though older age (RRR 0.79 per decade; 95% CI 0.71-0.87) and minority race/ethnicity predicted lower likelihood of use.

synapsesocial.com/papers/6a916f98d15324a1df3aa8a8 https://doi.org/10.1016/j.jamda.2026.106439

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August 28, 2026Journal of the American Medical Directors AssociationOpen Access

OAC use for AF in VA nursing homes reached ~47%, though age and racial disparities persist.

View Full Paper

Ask AI

Bookmark

Why the study?

What are the prevalence and predictors of oral anticoagulant use among veterans with atrial fibrillation in VA nursing homes after the 2014 ACC/AHA guideline?

Comparison

OAC ± aspirin vs aspirin alone vs neither

Design

Observational study

Key result

OAC use among VA nursing home residents with AF increased to 46.6% in 2019, though older age (RRR 0.79 per decade; 95% CI 0.71-0.87) and minority race/ethnicity predicted lower likelihood of use.

Authors

VMVeena Manja YLYongmei Li MSMichael A. Steinman

Discussion

Member takes

Overview

OAC underuse persists in VA nursing home residents with AF post-2014 guidelines; leaves open implementation barriers and optimal strategies in frail elderly.

Key Points

To evaluate the prevalence and predictors of oral anticoagulant and aspirin use among veterans with atrial fibrillation residing in Veterans Affairs long-term care facilities following the 2014 ACC/AHA guidelines.
Conducted an observational study of 4,994 Veterans Affairs nursing home residents with atrial fibrillation and a CHA2DS2-VASc score ≥2 admitted between October 1, 2014, and September 30, 2019.
Used multinomial logistic regression to identify demographic, functional, and clinical factors associated with receiving oral anticoagulants (with or without aspirin) or aspirin alone compared with neither therapy.
Age-standardized prevalence of any oral anticoagulant use increased from 31.2% in FY 2013–2014 to 46.6% in FY 2019, while aspirin monotherapy decreased from 47.7% to 39.3% and non-treatment decreased from 21.1% to 16.2%.
Older age per decade (RRR, 0.79; 95% CI, 0.71–0.87), Black race (RRR, 0.73; 95% CI, 0.58–0.91), and Hispanic ethnicity (RRR, 0.63; 95% CI, 0.44–0.91) were significantly associated with lower likelihood of receiving oral anticoagulants relative to neither therapy.
Cognitive impairment, greater disability, and concurrent non-aspirin antiplatelet use were also associated with significantly lower oral anticoagulant prescribing rates.

Study Design

Type

Observational (n=4,994)

Multicenter

Yes

Structured PICO

What are the prevalence and predictors of oral anticoagulant use among veterans with atrial fibrillation in VA nursing homes after the 2014 ACC/AHA guideline?

Population

4,994 Veterans Affairs nursing home residents with atrial fibrillation and a CHA2DS2-VASc score of ≥2, admitted between October 2014 and September 2019.

Exposure

Oral anticoagulants (OACs) ± aspirin or aspirin alone

Comparator

Neither anticoagulant nor aspirin use

Outcome

Prevalence and predictors of OACs and/or aspirin use

Main Result

Relative Risk: 0.79 (95% CI 0.71–0.87)

Despite increases in OAC use following the 2014 ACC/AHA guidelines, significant underuse remains among VA nursing home residents with AF, particularly in older, Black, and Hispanic veterans.

Cite This Study

synapsesocial.com/papers/6a916f98d15324a1df3aa8a8 https://doi.org/10.1016/j.jamda.2026.106439

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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