Practices and quality of optimal anticoagulation for patients with atrial fibrillation at Tikur Anbessa Specialized Hospital, a retrospective cross-sectional study: Insight from a low-income setting

Background: Atrial fibrillation (AF) is a major risk factor for stroke, and proper anticoagulation is one of the main pillars of treatment of atrial fibrillation to prevent cardioembolic complications. However, data on anticoagulation practices and quality are limited in Ethiopia. Therefore, this study aims to determine the status of anticoagulation therapy in high-risk atrial fibrillation patients and identify predictors of suboptimal anticoagulation among patients who had follow-up at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Methods: A retrospective cross-sectional study was conducted among 173 atrial fibrillation patients on follow-up at the TASH from March to September 2024. A pretested data abstraction tool was used to collect data from the patient’s chart and/or electronic medical record, and SPSS Ver 27 was used to analyze it. Anti-coagulation quality was assessed using Time in Therapeutic Range (TTR) with a target TTR of ≥65%. Descriptive statistics were used to summarize sociodemographics, comorbidity, anticoagulation type, CHA₂DS₂-VASc score, and quality of the practice. Multivariable logistic regression was applied to identify predictors of suboptimal anticoagulation, with statistical significance set at p<0.05. Results : A total of 173 adults with high-risk AF (mean age 64.7 ± 13.2 years; 64.7% female) were included. Of these, 90.2% were anticoagulated, while 9.8% were untreated. Among the 108 warfarin users, 76.9% had suboptimal International Normalized Ratio (INR) control (TTR ≤65%). Direct oral anticoagulants (DOACs) were prescribed to 30.7% (48/156) of anticoagulated patients, with 20.8% (10/48) exhibiting suboptimal anticoagulation. Overall, 59.6% (93/156) of anticoagulated patients had suboptimal anticoagulation. Logistic regression identified increasing age (AOR = 1.05, 95% CI: 1.02–1.09, p = 0.001) and community-based health insurance (CBHI) enrollment (AOR = 2.24, 95% CI: 1.08–4.67, p = 0.03) as significant predictors of suboptimal anticoagulation. Conclusion Suboptimal anticoagulation remains a significant challenge in Ethiopia, driven by factors such as age and CBHI. Expanding insurance coverage for DOACs and availing INR testing would improve the CHBI effectiveness in atrial fibrillation patients.