Strategies for improving guideline adherence of anticoagulants for patients with atrial fibrillation in primary healthcare: A systematic review

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


BACKGROUND: Clinical guidelines on atrial fibrillation management help optimize the use of oral anticoagulants. However, guideline non-adherence is common, particularly in the primary care setting. The primary aim of this systematic review was to identify effective strategies for improving adherence to guideline-directed thromboprophylaxis to patients with atrial fibrillation in the primary care setting.

METHODS: A search was conducted on 6 electronic databases (Medline, Embase, ScienceDirect, Scopus, the Cumulative Indexing of Nursing and Allied Health Literature, and Web of Science) supplemented by a Google advanced search. Studies aimed at improving oral thromboprophylaxis guideline adherence in patients with atrial fibrillation, in the primary care setting, were included in the study.

RESULTS: A total of 33 studies were included in this review. Nine studies employed electronic decision support (EDS), of which 4 reported modest improvements in guideline adherence. Five of 6 studies that utilized local guidelines as quality improvement measures reported improvement in guideline adherence. All 5 studies that employed coordinated care and the use of specialist support and 4 of the 5 studies that involved pharmacist-led interventions reported improvements in guideline adherence. Interventions based mainly on feedback from audits were less effective.

CONCLUSIONS: Multifaceted interventions, especially those incorporating coordinated care and specialist support, pharmacists, or local adaptations to and implementation of national and/or international guidelines appear to be more consistently effective in improving guideline adherence in the primary care setting than interventions based mainly on EDS and feedback from audits.

Original languageEnglish
Pages (from-to)128-136
Number of pages8
JournalThrombosis Research
Early online date29 Jul 2021
Publication statusPublished - 1 Sept 2021
Event12th PCNE Working Conference : Partnering for better patient outcomes- challenges and opportunities - Online
Duration: 3 Feb 20216 Feb 2021

Bibliographical note

We would like to acknowledge Mrs. Terena Solomons (librarian, Faculty of Sciences, UWA) for providing consultations to conduct a systematic search of the scientific literature. 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. Miss Deanna Mill is supported by an Australian Government Research Training Program (RTP) Scholarship at the University of Western Australia. Also, the abstract of this manuscript was presented online at the 12th PCNE (Pharmaceutical Care Network Europe) Working Conference 2021, Partnering for better patient outcomes-challenges and opportunities. The conference was held 3-6 February 2021.

Data Availability Statement

All data generated or analyzed during this study are included in this published article.

Supplementary data to this article can be found online at https://doi. org/10.1016/j.thromres.2021.07.014.


  • atrial fibrillation
  • anticoagulant
  • quality improvement tools
  • interventions
  • primary health care


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