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

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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.

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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.

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  1. Division of Pharmacy, School of Allied Health, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia

    Eyob Alemayehu Gebreyohannes, Sandra Salter & Kenneth Lee

  2. School of Pharmacy and Biomedical Sciences, Curtin University, Perth, WA, Australia

    Leanne Chalmers

  3. School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia

    Luke Bereznicki & Kenneth Lee

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Correspondence to Eyob Alemayehu Gebreyohannes.

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Eyob Alemayehu Gebreyohannes, Sandra Salter, Leanne Chalmers, Luke Bereznicki, and Kenneth Lee have no conflicts of interest that are directly relevant to the content of this article.

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EAG contributed to the concept and design and the literature search, wrote the first draft of the manuscript, critically revised the manuscript, and gave final approval of the submitted manuscript. SS, LC, LB, and KL contributed to the concept and design, critically revised the manuscript, and gave final approval of the submitted manuscript.

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Gebreyohannes, E.A., Salter, S., Chalmers, L. et al. Non-adherence to Thromboprophylaxis Guidelines in Atrial Fibrillation: A Narrative Review of the Extent of and Factors in Guideline Non-adherence. Am J Cardiovasc Drugs 21, 419–433 (2021). https://doi.org/10.1007/s40256-020-00457-3

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  • DOI: https://doi.org/10.1007/s40256-020-00457-3

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