Underuse of anticoagulation in patients with atrial fibrillation

ABSTRACT

Atrial fibrillation (AF) is a major risk factor for ischemic stroke. Guidelines recommend anticoagulation for patients with intermediate and high stroke risk (CHA₂DS₂-VASc score ≥2). Underuse of anticoagulants among eligible patients remains a persistent problem. Evidence demonstrates that the psychology of the fear of causing harm (omission bias) results in physicians’ hesitancy to initiate anticoagulation and an inaccurate estimation of stroke risk. The American Heart Association (AHA) initiated the Get With The Guidelines-AFIB (GWTG-AFIB) module in June 2013 to enhance guideline adherence for treatment and management of AF. Better quality of care for AF patients can be provided by increasing adherence to anticoagulation guidelines and improving patient compliance with anticoagulation therapy through education and established protocols. Nonvitamin K antagonist oral anticoagulants may facilitate better patient adherence due to ease of administration and reduced monitoring burden. In this review, we discuss the reasons for underuse, omission bias contributing to underuse, and different strategies to address this issue.

KEYWORDS:

• Atrial fibrillation
• Stroke
• Underuse
• Anticoagulants
• Warfarin
• Nonvitamin K antagonist oral anticoagulants

Declaration of interest

Writing and editorial support was provided by Terri Schochet, PhD, of AlphaBioCom, LLC, and funded by Daiichi Sankyo. Neither AlphaBioCom, LLC, or Daiichi Sankyo influenced content. WR Lewis is the Chair of the Get With The Guidelines-AFIB Workgroup of the American Heart Association. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.