Yusur Al-Hilali

University of Leeds, United Kingdom

Abstract Title: Assessing Adherence to Guideline-based DOAC prescribing in patients with Atrial Fibrillation: A primary care evaluation

Biography:

Research Interest:

Introduction: Atrial fibrillation is the most common cardiac arrhythmia in the UK and is a major risk factor for stroke. To prevent this, NICE guidelines recommend prescribing direct oral anticoagulants (DOACs) according to clinical parameters such as the CHA₂DS₂-VASc score. This study evaluated whether patients with AF in a UK primary care setting were prescribed these in accordance with guidelines and explored the associated clinical and financial implications. Methods: A retrospective review was conducted of 184 patients, aged 75-85 years with AF, receiving a DOAC for at least 3 months. Anonymised patient data were analysed, including relevant clinical parameters, then their dosages were compared with NICE recommendations to assess adherence. A financial analysis using British National Formulary (BNF) pricing was performed to estimate potential annual savings from standardising to the most cost effective generic DOAC. Results: Overall, 91% were prescribed the correct dosage, while 9% were incorrectly dosed. Of those incorrectly dosed, 71% were aged ≥80 years. Underdosing was the most frequent prescribing error. Among underdosed patients, 80% of patients had a CHA₂DS₂-VASc score of ≥5, indicating high thromboembolic risk. Standardising to a single generic DOAC was projected to save approximately £132,500 annually. Conclusion: A notable proportion of patients were prescribed suboptimal DOAC doses, highlighting the clinical need for review. Recommendations include targeted staff training, use of visual prescribing aids, and standardisation to the most cost-effective DOAC may improve both clinical safety and cost efficiency. A follow-up evaluation is planned for early 2026 to assess improvement.