Barriers to stroke prevention in Atrial Fibrillation: Insights from the global anticoagulation Roundtable

Area of Science:

• Cardiology
• Neurology
• Public Health

Background:

• Atrial fibrillation (AF) is a major contributor to the global burden of ischemic stroke, accounting for 25% of cases.
• Growing populations and rising stroke risk factors highlight an urgent need to address the underuse of antithrombotic therapy in AF patients.
• Failure to bridge gaps in AF care will exacerbate stroke-related morbidity and mortality, straining global healthcare systems.

Purpose of the Study:

• To underscore the critical need for recognizing and addressing the worldwide underutilization of antithrombotic therapy in patients with atrial fibrillation.
• To identify key patient, clinician, and societal barriers contributing to the gap in evidence-based stroke prevention for AF.
• To advocate for global and regional efforts to overcome these barriers and improve population health.

Main Methods:

• This study is a review and analysis of the current global landscape of AF care and stroke prevention.
• It synthesizes information on implementation science, healthcare system challenges, and patient-level factors.
• The analysis focuses on identifying barriers to adherence to evidence-based guidelines for antithrombotic therapy.

Main Results:

• Significant underutilization of antithrombotic therapy for stroke prevention in AF patients globally.
• Key barriers identified include inadequate provider education, limited public awareness, underdiagnosis of AF, and treatment underuse.
• Regional complexities such as medication availability, pharmacogenomic variations, socio-religious factors, and EHR limitations further complicate care.

Conclusions:

• Addressing the underutilization of antithrombotic therapy in AF is a global imperative to reduce stroke burden.
• Targeted interventions at both global and regional levels are necessary to overcome identified barriers.
• Investing in clinical tools and teams for stroke prevention in AF can significantly improve population health outcomes.