Non-adherence to Thromboprophylaxis Guidelines in Atrial Fibrillation: A Narrative Review of the Extent of and Factors in Guideline Non-adherence

Eyob Alemayehu Gebreyohannes* (Corresponding Author), Sandra Salter, Leanne Chalmers, Luke Bereznicki, Kenneth Lee

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

16 Citations (Scopus)

Abstract

Atrial fibrillation is the most common arrhythmia. It increases the risk of thromboembolism by up to fivefold. Guidelines provide evidence-based recommendations to effectively mitigate thromboembolic events using oral anticoagulants while minimizing the risk of bleeding. This review focuses on non-adherence to contemporary guidelines and the factors associated with guideline non-adherence. The extent of guideline non-adherence differs according to geographic region, healthcare setting, and risk stratification tools used. Guideline adherence has gradually improved over recent years, but a significant proportion of patients are still not receiving guideline-recommended therapy. Physician-related and patient-related factors (such as patient refusals, bleeding risk, older age, and recurrent falls) also contribute to guideline non-adherence, especially to undertreatment. Quality improvement initiatives that focus on undertreatment, especially in the primary healthcare setting, may help to improve guideline adherence.

Original languageEnglish
Pages (from-to)419-433
Number of pages15
JournalAmerican Journal of Cardiovascular Drugs
Volume21
Issue number4
Early online date28 Dec 2020
DOIs
Publication statusPublished - 28 Jul 2021

Bibliographical note

Acknowledgements
Mr. Eyob Alemayehu Gebreyohannes is a Ph.D. student and a recipient of the University of Western Australia International Fee Scholarship and University Postgraduate Award. Mr. Gebreyohannes would like to acknowledge the University of Western Australia for supporting his studies.

Funding
No sources of funding were used to conduct this study or prepare this manuscript.

Data Availability Statement

Availability of data and material
All data and material used for synthesis of this review are included in this manuscript.

Keywords

  • ADHERENCE
  • ANTITHROMBOTIC THERAPY GUIDELINES
  • ELDERLY-PATIENTS
  • INSIGHTS
  • MANAGEMENT
  • ORAL ANTICOAGULANTS
  • PRESCRIPTION
  • RISK
  • STROKE PREVENTION
  • UNDERUSE

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