Guideline adherence as an indicator of the extent of antithrombotic overuse and underuse: a systematic review

Cardona, M., Craig, L., Jones, M., Byambasuren, O., Obucina, M., Hattingh, L., Clark, J., Glasziou, P. and Hoffmann, T. (2022) Guideline adherence as an indicator of the extent of antithrombotic overuse and underuse: a systematic review. Global Heart, 17(1), 55. (doi: 10.5334/gh.1142) (PMID:36051325) (PMCID:PMC9374022)

Abstract

Thromboembolic events are a common risk in adults with atrial fibrillation, those with previous cerebrovascular accidents and undergoing emergency or elective surgeries. The widespread availability of antithrombotic agents and differing guidelines contribute to practice variations and increased risk of complications and deaths. The objective of this review was to investigate the extent of overuse and underuse of antithrombotics for primary or secondary prevention as measured by deviation from prescribing guideline recommendations. We conducted a systematic review of Medline and EMBASE for quantitative articles published between 2000 and 2021 and used a modified version of the Hoy's risk of bias assessment tool. Here we report evidence from the past decade about wide practice variations in hospitals and primary care, and discuss clinician and patient-driven determinants of non-adherence to guidelines. Finally, we summarise implications for practice, identify enhanced ways of measuring overuse and underuse, and propose potential solutions to the measurement challenges.

• Item Type: Articles
• Keywords: Guideline adherence, stroke - epidemiology - prevention and control, humans, thromboembolism - complications, atrial fibrillation - complications - drug therapy, review, guidelines, adult, fibrinolytic agents - therapeutic use, adherence.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Craig, Dr Louise
• Authors: Cardona, M., Craig, L., Jones, M., Byambasuren, O., Obucina, M., Hattingh, L., Clark, J., Glasziou, P., and Hoffmann, T.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Global Heart
• Publisher: Ubiquity Press
• ISSN: 2211-8160
• ISSN (Online): 2211-8179
• Published Online: 12 August 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Global Heart 17(1): 55
• Publisher Policy: Reproduced under a Creative Commons License