Clinical barriers to the use of recommended stroke prevention therapy

Stroke prevention therapy in atrial fibrillation is moderately tailored to recommended risk stratification. A minority of patients receiving a vitamin K antagonist have a proven effective time in therapeutic range for the international normalized ratio. Factors contributing to these evidence-practice gaps are 'clinical barriers'. Healthcare organization-level barriers include: lack of validated management tools, no structured patient education and follow-up, no practice support and inconsistent professional management guidelines. Healthcare provider-level barriers include: lack of guideline knowledge, disagreement with recommendations, fear for causing bleeding and lack of specialized skills. Patient-level barriers include: lack of knowledge regarding risk for stroke and benefit of therapy, disagreement with selected therapy, no noticeable benefit of therapy, polypharmacy and forgetfulness. Interventions to improve the implementation of stroke prevention for atrial fibrillation need to be tailored to identified clinical barriers. Potential solutions to overcome barriers include: organize care in according to anticoagulation clinic methods, educate providers and patients, use cost-effective validated management tools, active involvement of patient in care and encourage patient adherence.