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

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. 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. 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%). 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.

本系统评价与荟萃分析旨在系统性总结并定量估算埃塞俄比亚医院接受治疗的心房颤动（Atrial Fibrillation, AF）患者遵循抗凝治疗临床指南推荐的综合依从率。本研究通过PubMed、Cochrane图书馆、非洲专属数据库（非洲医学索引（African Index Medicus）、非洲在线期刊（African Journals Online））以及Google Scholar开展系统性文献检索。研究采用Microsoft Excel构建结构化提取模板进行数据提取，并将提取所得数据导入R 4.3.0版本软件进行分析。采用I²检验结合95%置信区间（Confidence Interval, CI）评估原始研究间的异质性；基于该检验结果，本研究采用随机效应荟萃分析模型，估算抗血栓治疗中符合国际指南推荐的综合依从率。本综述共纳入6项原始研究，结果显示，针对血栓栓塞事件高危且符合口服抗凝治疗指征的心房颤动患者，其抗血栓治疗遵循指南的综合依从率为55%（95%CI：33%~77%）。口服抗血栓治疗的指南依从率仅为55%，处于较低水平，致使大量高危患者仍面临血栓栓塞风险。需采用多维度干预手段（包括协同照护与药师参与）以提升指南依从性。