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Adherence to anticoagulation therapy in patients with atrial fibrillation: is a tailored team-based approach warranted?
  1. Jeroen Hendriks1,2,3,
  2. Celine Gallagher1,3,
  3. Karin Nyfort-Hansen1,4,
  4. Dennis Lau1,3,
  5. Prashanthan Sanders1,3
  1. 1Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
  2. 2Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
  3. 3Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  4. 4UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
  1. Correspondence to Dr Jeroen Hendriks, Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, SA 5001, Australia; jeroen.hendriks{at}adelaide.edu.au

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Assessment of risk factors for stroke and applying anticoagulation accordingly is one of the crucial fundamentals of comprehensive management of atrial fibrillation (AF). As the most prevalent sustained cardiac arrhythmia, AF is known to confer a fivefold increased risk of thromboembolic complications such as ischaemic stroke or transient ischaemic attack.1 International practice guidelines recommend the use of the CHA2DS2-VASc (C - Congestive heart failure; H - Hypertension, A - Age 75 and above, D - Diabetes Mellitus, S - prior Stroke or Transiant Ischaemic Attack or thromboembolism, V - Vascular disease history, A - Age 65-74, S - Female sex) score to predict the yearly risk of stroke and to determine if treatment with oral anticoagulation is warranted. Vitamin K antagonists as well as non-vitamin K antagonist oral anticoagulants (NOACs) are effective for the prevention of strokes in AF. However, regardless of the choice of anticoagulant, stringent adherence to the treatment regimen is crucial. Patients should play an active role in the decision to commence anticoagulation, and patient preferences should be taken into consideration, aiming to tailor the treatment as much as possible which may consequently improve treatment adherence.1

Unfortunately, adherence and persistence with anticoagulation treatment regimens is often suboptimal.2 The management of AF has become complex and the traditional healthcare consultation may no longer allow one healthcare professional enough time to educate the patient about stroke prevention therapy, engage in shared decision making and discuss the importance of adherence for optimal outcomes. Nevertheless, engaging with patients to identify their values, preferences and beliefs, explaining the rationale of stroke prevention as part of AF management and providing information about treatment options, is crucial to reach an informed or …

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Footnotes

  • Twitter @J_Hendriks1, @PrashSanders

  • Correction notice This article has been corrected since it was published Online First. The twitter handle for Jeroen Hendriks was added

  • Contributors All authors have contributed to the manuscript and have agreed for the final version of the manuscript to be submitted to the Journal.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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