ReviewKorean circulation journal2019
Reducing Stroke Risk in Atrial Fibrillation: Adherence to Guidelines Has Improved, but Patient Persistence with Anticoagulant Therapy Remains Suboptimal.
Review in Korean circulation journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Antithrombotics prescription and adherence among stroke survivors: A systematic review and meta-analysis.Brain and behavior · 2022Pooled it
- Non-adherence to Thromboprophylaxis Guidelines in Atrial Fibrillation: A Narrative Review of the Extent of and Factors in Guideline Non-adherence.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2021Pooled it
- Mental Health Conditions and Nonpersistence of Direct Oral Anticoagulant Use in Patients With Incident Atrial Fibrillation: A Nationwide Cohort Study.Journal of the American Heart Association · 2022Trial
- Patient perspectives on atrial fibrillation management and pharmacist roles in outpatient clinics: a qualitative study.International journal of clinical pharmacy · 2026Article
- Association of oral anticoagulation persistence and health-related quality of life in stroke survivors with atrial fibrillation: long-term results of the Berlin atrial fibrillation registry.Neurological research and practice · 2026Article
- Article
- Oral anticoagulation in patients with gastrointestinal bleeding and new-onset atrial fibrillation: A population-based registry-linkage study.Journal of internal medicine · 2025Article
- Evaluation of the treatment patterns among commercially insured patients with nonvalvular atrial fibrillation prescribed an oral anticoagulant by race/ethnicity.Journal of comparative effectiveness research · 2025Article
- Cost-effectiveness of a clinical decision support system for atrial fibrillation: an RCT-based modelling study.European heart journal. Digital health · 2025Article
- Time trends in stroke risk management among high-risk patients with non-valvular atrial fibrillation in Australia between 2011-2019.International journal of cardiology. Heart & vasculature · 2024Article
- Long-term outcomes after hospitalization for atrial fibrillation or flutter.European heart journal · 2024Article
- Opportunistic atrial fibrillation screening in primary care in Ireland: results of a pilot screening programme.Open heart · 2024Article
- Article
- Assessing adherence to treatment guidelines and complications among atrial fibrillation patients in the United Arab Emirates.Frontiers in cardiovascular medicine · 2024Article
- Generalisability of and lessons learned from a mixed-methods study conducted in three low- and middle-income countries to identify care pathways for atrial fibrillation.Global health action · 2023Article
- Hemorrhagic Coagulation Disorders and Ischemic Stroke: How to Reconcile Both?Neurology international · 2023Review
- Trends in treatment and outcomes of atrial fibrillation during 2007-17 in Finland.European heart journal. Quality of care & clinical outcomes · 2023Article
- Determinants and clinical outcomes of patients who refused anticoagulation: findings from the global GARFIELD-AF registry.Open heart · 2023Article
- The pathway to diagnosis and follow-up care for atrial fibrillation in Sri Lanka: a descriptive longitudinal study.NIHR open research · 2023Article
- Underprescribing vs underfilling to oral anticoagulation: An analysis of linked medical record and claims data for a nationwide sample of patients with atrial fibrillation.Journal of managed care & specialty pharmacy · 2022Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
Atrial fibrillation (AF) is a significant risk factor for avoidable stroke. Among high-risk patients with AF, stroke risk can be mitigated using oral anticoagulants (OACs), however reduction is largely contingent on physician prescription and patient persistence with OAC therapy. Over the past decade significant advances have occurred, with revisions to clinical practice guidelines relating to management of stroke risk in AF in several countries, and the introduction of non-vitamin K antagonist OACs (NOACs). This paper summarises the evolving body of research examining guideline-based clinician prescription over the past decade, and patient-level factors associated with OAC persistence. The review shows clinicians' management over the past decade has increasingly reflected guideline recommendations, with an increasing proportion of high-risk patients receiving OACs, driven by an upswing in NOACs. However, a treatment gap remains, as 25-35% of high-risk patients still do not receive OAC treatment, with great variation between countries. Reduction in stroke risk directly relates to level of OAC prescription and therapy persistence. Persistence and adherence to OAC thromboprophylaxis remains an ongoing issue, with 2-year persistence as low as 50%, again with wide variation between countries and practice settings. Multiple patient-level factors contribute to poor persistence, in addition to concerns about bleeding. Considered review of individual patient's factors and circumstances will assist clinicians to implement appropriate strategies to address poor persistence. This review highlights the interplay of both clinician's awareness of guideline recommendations and understanding of individual patient-level factors which impact adherence and persistence, which are required to reduce the incidence of preventable stroke attributable to AF.
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