Background and Aim
For atrial fibrillation (AF) patients with a high risk of stroke (CHA2DS2-VASC > 1), an oral anticoagulation (OAC) with vitamin K antagonists (VKA) or new oral anticoagulants (NOAC) are recommended by German and international guidelines. This review aims to systematically present previous evidence on the extent of undertreatment of oral anticoagulation of patients with atrial fibrillation in Germany, as well as potential reasons for the existing undertreatment.
Method
According to the extent of undertreatment of oral anticoagulation, a review of the German and English literature was carried out, which addressed the German care “environment”. Due to the absence of German data, all relevant international literature was included in the review to determine the reasons for undertreatment of oral anticoagulation.
Results
A total of 4 contributions that were dedicated to the undertreatment of oral anticoagulation for patients with atrial fibrillation in Germany, as well as 87 publications referring to the reasons for undertreatment of oral anticoagulation, were identified.
Approximately 50 % of patients with atrial fibrillation treated in Germany are affected by undertreatment of oral anticoagulation. Undertreatment of oral anticoagulation is a care deficit and is based on multivariate causal factors or is associated with different factors. Four major groups of causal factors with several dominant specific causes can be distinguished: patient-related medical factors (former bleeding and bleeding risk, risk of falls, cancer, paroxysmal AF instead of permanent/persistent AF), general characteristics of patients (old age, non-adherence), physician-related factors (physician knowledge and physician-sided cost–benefit analysis of OAC), and other factors usually associated with the care “environment” of patients (logistics and other factors in the context of „Internal-normalized-ratio“(INR)-controls)
Conclusion
Undertreatment of oral anticoagulation of patients with atrial fibrillation is a great challenge with respect to care. The complexity of reasons for undertreatment should be urgently considered by programs trying to optimize this undertreatment of oral anticoagulation for patients with atrial fibrillation.