Adherence to clinical guideline recommendation for anticoagulation therapy among Ethiopian patients with atrial fibrillation eligible for thromboembolism prophylaxis: a systematic review and meta-analysis

Abstract

Objectives: This systematic review and meta-analysis focused on summarizing and quantitatively estimating the pooled adherence rates to clinical guideline recommendations for anticoagulation therapy in patients with AF receiving treatment in Ethiopian hospitals.

Methods: The Systematic literature search was conducted in PubMed, Cochrane Library, Africa-specific databases (African Index Medicus, and African Journals Online), and Google Scholar. Data were extracted in a structured format prepared using Microsoft Excel. The extracted data were exported to R software Version 4.3.0 for analysis. The I2 test was used to check the heterogeneity between primary studies with a corresponding 95% confidence interval (CI). Based on the test result, a random-effects meta-analysis model was used to estimate pooled effect adherence rate to the international guideline in antithrombotic therapy.

Results: The review included a total of 6 primary studies with the pooled adherence rate to guidelines in antithrombotic therapy use in patients diagnosed with AF who are at high risk for thromboembolic events and eligible for oral anticoagulants was found to be 55% (95% CI: 33% to 77%).

Conclusion: Guideline adherence for oral antithrombotic therapy was low (55%), leaving many high-risk patients vulnerable. Multifaceted interventions, including coordinated care and pharmacist involvement, are needed to improve adherence.

Keywords: Atrial fibrillation; adherence; adherence to guidelines; anticoagulation; thromboembolism.