Improving the Prescription of Oral Anticoagulants in Atrial Fibrillation: A Systematic Review

Ruth V Pritchett; Danai Bem; Grace M Turner; G Neil Thomas; Joanne L Clarke; Rebecca Fellows; Deirdre A Lane; Kate Jolly

doi:10.1055/s-0038-1676835

Improving the Prescription of Oral Anticoagulants in Atrial Fibrillation: A Systematic Review

Ruth V Pritchett, Danai Bem, Grace M Turner, G Neil Thomas, Joanne L Clarke, Rebecca Fellows, Deirdre A Lane, Kate Jolly

Research output: Contribution to journal › Review article › peer-review

46 Citations (Scopus)

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Abstract

OBJECTIVE: Oral anticoagulant (OAC) prescription for stroke prevention in atrial fibrillation (AF) patients frequently does not follow current guidelines, with underuse in patients at high risk of stroke and substantial overuse in those at low risk. This review aims to systematically evaluate the effectiveness of interventions to improve appropriate OAC prescription in eligible AF patients for stroke prevention.

METHODS: Systematic review of controlled and uncontrolled studies published up to July 2017 with interventions designed to improve appropriate OAC prescription for stroke prevention in eligible AF patients (according to risk assessment tool or guidelines). Categorization of intervention types was pre-specified. The main outcome was change in proportion of eligible AF patients prescribed OACs for stroke prevention.

RESULTS: Twenty studies conducted in 392 settings were included (cluster randomized controlled trials, controlled trials and uncontrolled before-after designs; n = 29,868 patients at baseline). Fifteen studies reported significant improvements in appropriate prescription of OACs in AF patients. All interventions with a persuasive element (8/8); all studies targeting health care professional (HCP) education or guideline/protocol implementation (7/7); and all medical care programs (4/4) achieved significant increases in appropriate OAC prescription. Computerized decision support interventions (3/5) and reviews of prescribing (2/4) were less likely to report significant improvements in appropriate OAC prescription.

CONCLUSION: Interventions designed to improve appropriate prescription of OACs in eligible AF patients for stroke prevention can be effective. Successful approaches include education of HCPs; implementation of local guidelines; interdisciplinary medical care programs educating both HCPs and patients and persuasive interventions utilizing peer-group experts. Protocol registration: PROSPERO (CRD42016039654).

Original language	English
Journal	Thrombosis and Haemostasis
Volume	119
Issue number	2
Pages (from-to)	294-307
Number of pages	14
ISSN	0340-6245
DOIs	https://doi.org/10.1055/s-0038-1676835
Publication status	Published - Feb 2019

Keywords

atrial fibrillation
intervention
oral anticoagulation
stroke prevention
systematic review

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s-0038-1676835Final published version, 269 KBLicence: CC BY-NC-ND 4.0

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@article{370097f5afe348db83a4b6b8831229d0,

title = "Improving the Prescription of Oral Anticoagulants in Atrial Fibrillation: A Systematic Review",

abstract = "OBJECTIVE: Oral anticoagulant (OAC) prescription for stroke prevention in atrial fibrillation (AF) patients frequently does not follow current guidelines, with underuse in patients at high risk of stroke and substantial overuse in those at low risk. This review aims to systematically evaluate the effectiveness of interventions to improve appropriate OAC prescription in eligible AF patients for stroke prevention.METHODS: Systematic review of controlled and uncontrolled studies published up to July 2017 with interventions designed to improve appropriate OAC prescription for stroke prevention in eligible AF patients (according to risk assessment tool or guidelines). Categorization of intervention types was pre-specified. The main outcome was change in proportion of eligible AF patients prescribed OACs for stroke prevention.RESULTS: Twenty studies conducted in 392 settings were included (cluster randomized controlled trials, controlled trials and uncontrolled before-after designs; n = 29,868 patients at baseline). Fifteen studies reported significant improvements in appropriate prescription of OACs in AF patients. All interventions with a persuasive element (8/8); all studies targeting health care professional (HCP) education or guideline/protocol implementation (7/7); and all medical care programs (4/4) achieved significant increases in appropriate OAC prescription. Computerized decision support interventions (3/5) and reviews of prescribing (2/4) were less likely to report significant improvements in appropriate OAC prescription.CONCLUSION: Interventions designed to improve appropriate prescription of OACs in eligible AF patients for stroke prevention can be effective. Successful approaches include education of HCPs; implementation of local guidelines; interdisciplinary medical care programs educating both HCPs and patients and persuasive interventions utilizing peer-group experts. Protocol registration: PROSPERO (CRD42016039654).",

keywords = "atrial fibrillation, intervention, oral anticoagulation, stroke prevention, systematic review",

author = "Pritchett, {Ruth V} and Danai Bem and Turner, {Grace M} and Thomas, {G Neil} and Clarke, {Joanne L} and Rebecca Fellows and Lane, {Deirdre A} and Kate Jolly",

note = "Georg Thieme Verlag KG Stuttgart · New York.",

year = "2019",

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doi = "10.1055/s-0038-1676835",

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T1 - Improving the Prescription of Oral Anticoagulants in Atrial Fibrillation

T2 - A Systematic Review

AU - Pritchett, Ruth V

AU - Bem, Danai

AU - Turner, Grace M

AU - Thomas, G Neil

AU - Clarke, Joanne L

AU - Fellows, Rebecca

AU - Lane, Deirdre A

AU - Jolly, Kate

N1 - Georg Thieme Verlag KG Stuttgart · New York.

PY - 2019/2

Y1 - 2019/2

N2 - OBJECTIVE: Oral anticoagulant (OAC) prescription for stroke prevention in atrial fibrillation (AF) patients frequently does not follow current guidelines, with underuse in patients at high risk of stroke and substantial overuse in those at low risk. This review aims to systematically evaluate the effectiveness of interventions to improve appropriate OAC prescription in eligible AF patients for stroke prevention.METHODS: Systematic review of controlled and uncontrolled studies published up to July 2017 with interventions designed to improve appropriate OAC prescription for stroke prevention in eligible AF patients (according to risk assessment tool or guidelines). Categorization of intervention types was pre-specified. The main outcome was change in proportion of eligible AF patients prescribed OACs for stroke prevention.RESULTS: Twenty studies conducted in 392 settings were included (cluster randomized controlled trials, controlled trials and uncontrolled before-after designs; n = 29,868 patients at baseline). Fifteen studies reported significant improvements in appropriate prescription of OACs in AF patients. All interventions with a persuasive element (8/8); all studies targeting health care professional (HCP) education or guideline/protocol implementation (7/7); and all medical care programs (4/4) achieved significant increases in appropriate OAC prescription. Computerized decision support interventions (3/5) and reviews of prescribing (2/4) were less likely to report significant improvements in appropriate OAC prescription.CONCLUSION: Interventions designed to improve appropriate prescription of OACs in eligible AF patients for stroke prevention can be effective. Successful approaches include education of HCPs; implementation of local guidelines; interdisciplinary medical care programs educating both HCPs and patients and persuasive interventions utilizing peer-group experts. Protocol registration: PROSPERO (CRD42016039654).

AB - OBJECTIVE: Oral anticoagulant (OAC) prescription for stroke prevention in atrial fibrillation (AF) patients frequently does not follow current guidelines, with underuse in patients at high risk of stroke and substantial overuse in those at low risk. This review aims to systematically evaluate the effectiveness of interventions to improve appropriate OAC prescription in eligible AF patients for stroke prevention.METHODS: Systematic review of controlled and uncontrolled studies published up to July 2017 with interventions designed to improve appropriate OAC prescription for stroke prevention in eligible AF patients (according to risk assessment tool or guidelines). Categorization of intervention types was pre-specified. The main outcome was change in proportion of eligible AF patients prescribed OACs for stroke prevention.RESULTS: Twenty studies conducted in 392 settings were included (cluster randomized controlled trials, controlled trials and uncontrolled before-after designs; n = 29,868 patients at baseline). Fifteen studies reported significant improvements in appropriate prescription of OACs in AF patients. All interventions with a persuasive element (8/8); all studies targeting health care professional (HCP) education or guideline/protocol implementation (7/7); and all medical care programs (4/4) achieved significant increases in appropriate OAC prescription. Computerized decision support interventions (3/5) and reviews of prescribing (2/4) were less likely to report significant improvements in appropriate OAC prescription.CONCLUSION: Interventions designed to improve appropriate prescription of OACs in eligible AF patients for stroke prevention can be effective. Successful approaches include education of HCPs; implementation of local guidelines; interdisciplinary medical care programs educating both HCPs and patients and persuasive interventions utilizing peer-group experts. Protocol registration: PROSPERO (CRD42016039654).

KW - atrial fibrillation

KW - intervention

KW - oral anticoagulation

KW - stroke prevention

KW - systematic review

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SN - 0340-6245

VL - 119

SP - 294

EP - 307

JO - Thrombosis and Haemostasis

JF - Thrombosis and Haemostasis

IS - 2

ER -

Improving the Prescription of Oral Anticoagulants in Atrial Fibrillation: A Systematic Review

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