Atrial fibrillation is the most common arrhythmia. It increases the risk of thromboembolism by up to fivefold. Guidelines provide evidence-based recommendations to effectively mitigate thromboembolic events using oral anticoagulants while minimizing the risk of bleeding. This review focuses on non-adherence to contemporary guidelines and the factors associated with guideline non-adherence. The extent of guideline non-adherence differs according to geographic region, healthcare setting, and risk stratification tools used. Guideline adherence has gradually improved over recent years, but a significant proportion of patients are still not receiving guideline-recommended therapy. Physician-related and patient-related factors (such as patient refusals, bleeding risk, older age, and recurrent falls) also contribute to guideline non-adherence, especially to undertreatment. Quality improvement initiatives that focus on undertreatment, especially in the primary healthcare setting, may help to improve guideline adherence.

房颤是最常见的心律失常。它使血栓栓塞的风险增加多达五倍。指南提供了循证建议，以使用口服抗凝剂有效减轻血栓栓塞事件，同时将出血风险降至最低。本综述重点关注不遵守当代指南以及与不遵守指南相关的因素。不遵守指南的程度因地理区域、医疗保健环境和使用的风险分层工具而异。近年来，指南依从性逐渐提高，但仍有很大一部分患者未接受指南推荐的治疗。医生相关和患者相关的因素（如患者拒绝、出血风险、年龄较大和反复跌倒）也会导致不遵守指南，尤其是治疗不足。专注于治疗不足的质量改进计划，尤其是在初级医疗保健环境中，可能有助于提高指南的依从性。