Underuse of anticoagulation in atrial fibrillation patients with a CHA2DS2-VASc score ≥ 2 is driven by omission bias and may be improved by guideline adherence programs and novel oral anticoagulants.
This review highlights the persistent underuse of anticoagulation in eligible AF patients due to omission bias and suggests strategies like NOACs and established protocols to improve guideline adherence.
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.
Vallakati et al. (Tue,) conducted a review in Atrial fibrillation. Anticoagulation was evaluated. Underuse of anticoagulation in atrial fibrillation patients with a CHA2DS2-VASc score ≥ 2 is driven by omission bias and may be improved by guideline adherence programs and novel oral anticoagulants.