UNSTRUCTURED ABSTRACT
Optimising guideline-directed anticoagulation in atrial fibrillation remains a perennial
problem despite strong evidence for improved health outcomes with use of guideline-directed
anticoagulation. Efforts to improve uptake have been hampered by barriers found at
the level of the physician, patient, disease and choices of therapy. Clinician judgement
is often clouded by factors such as therapeutic inertia, aversion to bleeding risk
and implicit bias. For patients, negative pre-conceptions of therapy, impact of therapy
on day-to-day life and the nocebo effect pose significant barriers. Both groups are
impacted by poor education. Utility of a single pronged approach directed towards
clinicians or patients have demonstrated variable success, with the highest impact
appreciated in studies employing shared decision models. Further, there is emerging
evidence for use of integrated models of care, which have shown improved efficacy
in improving patient outcomes, as well as use of digital platforms such as mobile
app-based interventions, which can be of aid to the clinician in improving patient
adherence to anticoagulation with translated improved outcomes in clinical trials.
Our narrative review article aims to investigate the physician and health system,
patient, as well as drug therapy and disease barriers to uptake of guideline-directed
anticoagulation in treatment of non-valvular atrial fibrillation.
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Article info
Publication history
Accepted:
January 22,
2023
Received in revised form:
January 22,
2023
Received:
February 9,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of interest: A.B. and T.C.T. report unrelated institutional grants for performing research in the field of atrial fibrillation from Bayer Healthcare (developer of rivaroxaban). All other authors report no competing interests.
Funding: None.
WORD SUMMARY
In recent years, much attention has been directed to preventing atrial fibrillation-associated stroke through the use of guideline-directed anticoagulation. Scientific focus is now being shifted towards translating the benefits of guideline-based therapy from randomized controlled trials to real community outcomes. Investigating the physician and health system, patient, as well as drug therapy and disease barriers to uptake of guideline-directed anticoagulation will provide an informed roadmap to appropriate use of anticoagulation in real world settings.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
