Gebreyohannes Eyob Alemayehu, Salter Sandra, Chalmers Leanne, Bereznicki Luke, Lee Kenneth
Division of Pharmacy, School of Allied Health, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.
School of Pharmacy and Biomedical Sciences, Curtin University, Perth, WA, Australia.
Am J Cardiovasc Drugs. 2021 Jul;21(4):419-433. doi: 10.1007/s40256-020-00457-3. Epub 2020 Dec 28.
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.
心房颤动是最常见的心律失常。它会使血栓栓塞风险增加多达五倍。指南提供了基于证据的建议，以通过使用口服抗凝剂有效减轻血栓栓塞事件，同时将出血风险降至最低。本综述重点关注对当代指南的不依从性以及与指南不依从相关的因素。指南不依从的程度因地理区域、医疗环境和所使用的风险分层工具而异。近年来，指南依从性已逐渐改善，但仍有很大比例的患者未接受指南推荐的治疗。与医生和患者相关的因素（如患者拒绝、出血风险、老年和反复跌倒）也导致指南不依从，尤其是治疗不足。关注治疗不足的质量改进举措，特别是在初级医疗环境中，可能有助于提高指南依从性。
