Non-vitamin K antagonist oral anticoagulants and atrial fibrillation guidelines in practice: Barriers to and strategies for optimal implementation

A. John Camm, Fausto J. Pinto, Graeme J. Hankey, Felicita Andreotti, F. D.Richard Hobbs, A. John Camm, F. D. Richard Hobbs, László Csiba, Gabriel R. De Freitas, Shinya Goto, Carlos Cantú, Jorge Gonzalez-Zuelgaray, Werner Hacke, Han Hwa Hu, Lorenzo Mantovani, Byung Woo Yoon, Dayi Hu, Kui Hian Sim

Research output: Contribution to journalReview articlepeer-review

43 Citations (Scopus)


Stroke is a leading cause of morbidity and mortality worldwide. Atrial fibrillation (AF) is an independent risk factor for stroke, increasing the risk five-fold. Strokes in patients with AF are more likely than other embolic strokes to be fatal or cause severe disability and are associated with higher healthcare costs, but they are also preventable. Current guidelines recommend that all patients with AF who are at risk of stroke should receive anticoagulation. However, despite this guidance, registry data indicate that anticoagulation is still widely underused. With a focus on the 2012 update of the European Society of Cardiology (ESC) guidelines for the management of AF, the Action for Stroke Prevention alliance writing group have identified key reasons for the suboptimal implementation of the guidelines at a global, regional, and local level, with an emphasis on access restrictions to guideline-recommended therapies. Following identification of these barriers, the group has developed an expert consensus on strategies to augment the implementation of current guidelines, including practical, educational, and access-related measures. The potential impact of healthcare quality measures for stroke prevention on guideline implementation is also explored. By providing practical guidance on how to improve implementation of the ESC guidelines, or region-specific modifications of these guidelines, the aim is to reduce the potentially devastating impact that stroke can have on patients, their families and their carers.

Original languageEnglish
Pages (from-to)1007-1017
Number of pages11
Issue number7
Publication statusPublished - Jan 1 2015


  • Atrial fibrillation
  • Guidelines
  • Oral anticoagulants
  • Stroke prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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