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January 9, 2026BMJ Open QualityOpen Access

Enhancing adherence to guideline-directed use of anticoagulant therapy in atrial fibrillation: a triad of quality improvement interventions in an academic outpatient setting

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Key result

A triad of quality improvement interventions significantly increased guideline-concordant anticoagulation use among eligible patients with atrial fibrillation.

Authors

KXKun Kevin XiangANAsinamai M NdaiRRRachel Reise

Discussion

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Overview

Quality improvement interventions increase guideline-concordant anticoagulant use in atrial fibrillation patients, indicating improved patient care.

Key Points

  • The aim is to enhance adherence to guideline-directed anticoagulant therapy in patients with atrial fibrillation.
  • Implemented a triad of interventions: best practice alert, clinician education, and patient communication.
  • Conducted interventions across primary care and cardiology outpatient clinics.
  • Collected patient-level data during a 6-month intervention period and compared it with a historical control.
  • Utilized generalised estimating equations with a logistic link for data analysis.
  • Anticoagulation rate increased from 75.7% to 79.2%.
  • Intervention period patients had higher odds of anticoagulant use (adjusted OR 1.13).
  • MyChart activation was significantly associated with increased anticoagulant use (adjusted OR 1.38).
  • Older age and higher CHA2DS2-VASc scores linked to greater odds of use.
  • Higher HAS-BLED scores and care in primary care showed lower odds of anticoagulant use.

PICO

P
Population
Atrial Fibrillation (n=3,274)
I
Intervention / Comparator
Triad of quality improvement interventions vs Historical control period (October 2021 - March 2022)
O
Primary Outcome
Anticoagulation use in eligible patients with non-valvular AF — aOR 1.13 (1.05 to 1.21), p=0.0007

Main Result

Effect estimate: aOR 1.13 (95% CI 1.05 to 1.21)

Absolute Event Rate: 79.2% vs 75.7%

p-value: p=0.0007

Limitations

  • The specific contributions of each intervention component could not be determined.
  • The study was conducted within one organization, limiting generalizability.
  • The response rate to the patient survey was low (4.7%).

Cite This Study

Xiang et al. (2026) studied Atrial Fibrillation (n=3,274). Triad of quality improvement interventions vs. Historical control period (October 2021 - March 2022) was evaluated on Anticoagulation use in eligible patients with non-valvular AF (aOR 1.13, 95% CI 1.05 to 1.21, p=0.0007). A triad of quality improvement interventions significantly increased guideline-concordant anticoagulation use among eligible patients with atrial fibrillation.

synapsesocial.com/papers/696128f244c2cd6c68456c69https://doi.org/10.1136/bmjoq-2025-003311
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Effect of Clinical Decision Support Alerts on Anticoagulation Management in Atrial Fibrillation2025
  2. 2Direct oral anticoagulation management to address primary and secondary adherence in atrial fibrillation2025
  3. 3Nonvalvular Atrial Fibrillation and Anticoagulation in the Elderly: A Retrospective Cohort Study2026
  4. 4Disparities in anticoagulation therapy for older adults with non-valvular atrial fibrillation: a comparative study of urban and suburban communities2026
  5. 5Anticoagulation for Atrial Fibrillation with Intermediate Stroke Risk2026