Monitoring of quality of care for atrial fibrillation after guideline introduction in Cyprus
Abstract
Issue: Atrial fibrillation (AF) is a major contributor to morbidity and mortality in the elderly, and its effective management can reduce the associated health burden. However, real-world evidence shows persistent gaps in relevant guidelines’ implementation in Europe and elsewhere. In 2023, Cyprus contextualised the NICE NG196 AF guideline within its national health system and introduced measurable quality-of-care indicators.
Description of the problem: We evaluated guideline implementation through four indicators using national electronic health records across three periods: baseline (2022–2023) and two post-implementation years (2023–2025). Indicators captured key management domains: anticoagulation, screening, patient safety monitoring, and stroke risk stratification.
Results: The proportion of AF patients admitted for stroke on anticoagulation increased from 61.1% at baseline to 69.3% in year one (+8.2%, p = 0.086), with no further improvement in year two. More interestingly, pulse rhythm assessment in high-risk individuals improved markedly from 17.1% to 39.4% (+22.3%, p < 0.001) and further to 51.4% in year two (+12%, p < 0.001). In contrast, safety monitoring in anticoagulated patients was suboptimal at baseline and year one (67.8%) and declined to 58.6% in year two (−9.2%, p < 0.001), while stroke risk stratification using the CHA₂DS₂-VASc score was very limited, at 1.2% after implementation.
Lessons: Improvements were observed in anticoagulation and screening, but critical gaps remain in safety monitoring and risk stratification. Our findings highlight the need for stronger, system-level implementation, including decision support tools, incentives and integration of key practices into routine workflows.
Key messages: • Atrial Fibrillation guideline implementation in Cyprus improved screening and anticoagulation but revealed major gaps in patient safety monitoring and risk stratification.
• System-level and indicator-based monitoring can strengthen quality of care and reduce cardiovascular burden.
Related
- Heart Failure Progression in the Setting of Persistent Atrial Fibrillation, Frequent Premature Ventricular Complexes, and Malignancy-Related Limitations to Guideline-Directed Medical Therapy: A Case Report.
- Incidence and timing of new-onset atrial fibrillation after transcatheter aortic valve implantation: 14-day electrocardiographic monitoring
- Totally Thoracoscopic Atrial Fibrillation Ablation With the Gemini S Bipolar Clamp: A Single‐Center Descriptive Cohort Study of 1‐Year Rhythm, Safety, and Quality‐of‐Life Outcomes
- Atrial Cardiomyopathy and Ischemic Stroke: A Monitoring-Integrated Staging and Phenotyping Framework Beyond Atrial Fibrillation
- Circadian patterns of device-detected postoperative atrial fibrillation during 2.5 years of continuous monitoring after cardiac surgery: The RACE V-Tissue Bank Study.
BibTeX
@article{kouis2026monitoring,
title = {{Monitoring of quality of care for atrial fibrillation after guideline introduction in Cyprus}},
author = {P Kouis and A Sioftanos and T Christophides and M Kyriacou and H Achilleos and O Kolokotroni and A Yiallourou and E Papasavvas and PK Yiallouros and GK Nikolopoulos},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.780},
url = {https://doi.org/10.1093/eurpub/ckag169.780},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Monitoring of quality of care for atrial fibrillation after guideline introduction in Cyprus
AU - P Kouis
AU - A Sioftanos
AU - T Christophides
AU - M Kyriacou
AU - H Achilleos
AU - O Kolokotroni
AU - A Yiallourou
AU - E Papasavvas
AU - PK Yiallouros
AU - GK Nikolopoulos
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.780
UR - https://doi.org/10.1093/eurpub/ckag169.780
AB - Issue: Atrial fibrillation (AF) is a major contributor to morbidity and mortality in the elderly, and its effective management can reduce the associated health burden. However, real-world evidence shows persistent gaps in relevant guidelines’ implementation in Europe and elsewhere. In 2023, Cyprus contextualised the NICE NG196 AF guideline within its national health system and introduced measurable quality-of-care indicators. Description of the problem: We evaluated guideline implementation through four indicators using national electronic health records across three periods: baseline (2022–2023) and two post-implementation years (2023–2025). Indicators captured key management domains: anticoagulation, screening, patient safety monitoring, and stroke risk stratification. Results: The proportion of AF patients admitted for stroke on anticoagulation increased from 61.1% at baseline to 69.3% in year one (+8.2%, p = 0.086), with no further improvement in year two. More interestingly, pulse rhythm assessment in high-risk individuals improved markedly from 17.1% to 39.4% (+22.3%, p < 0.001) and further to 51.4% in year two (+12%, p < 0.001). In contrast, safety monitoring in anticoagulated patients was suboptimal at baseline and year one (67.8%) and declined to 58.6% in year two (−9.2%, p < 0.001), while stroke risk stratification using the CHA₂DS₂-VASc score was very limited, at 1.2% after implementation. Lessons: Improvements were observed in anticoagulation and screening, but critical gaps remain in safety monitoring and risk stratification. Our findings highlight the need for stronger, system-level implementation, including decision support tools, incentives and integration of key practices into routine workflows. Key messages: • Atrial Fibrillation guideline implementation in Cyprus improved screening and anticoagulation but revealed major gaps in patient safety monitoring and risk stratification. • System-level and indicator-based monitoring can strengthen quality of care and reduce cardiovascular burden.
SN - 1101-1262
SN - 1464-360X
ER -