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IMPACT-AF: Educational intervention increases oral anticoagulant use
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The proportion of patients with AF at risk for stroke who received treatment with oral anticoagulation significantly increased due to an educational intervention, according to the results of the IMPACT-AF trial published in The Lancet.
According to the study, AF accounts for one in five ischemic strokes.
“At least two thirds of these AF-related strokes can be prevented by oral anticoagulation,” Dragos Vinereanu, PhD, from the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital in Bucharest, Romania, and colleagues wrote. “Nevertheless, only about half of patients for whom current guidelines recommend oral anticoagulation are treated, resulting in a substantial number of preventable ischemic strokes.”
A total of 2,281 patients from four countries were enrolled in the two-arm, prospective, international, cluster-randomized, controlled trial to assess the impact of a multifaceted educational intervention compared with usual care on oral anticoagulants in patients with AF.
Patients were randomly assigned to an intervention group that received the usual care plus an educational initiative, or to a control group that received the usual care alone.
In the intervention group, patients and their families received educational brochures and access to web-based and video educational materials and were encouraged to interact with caregivers about the benefits and risks of oral anticoagulation, while providers received a review of current guideline recommendations, regular emails with relevant articles, phone interactions with the coordinating center and access to relevant webinars, podcasts, monographs, social media and instant messaging.
The primary outcome was change in the proportion of patients treated with oral anticoagulants from baseline to 1 year.
Patients were followed up at a median of 1 year (interquartile range, 11.8-12.2 months).
At 1 year, oral anticoagulant use increased from 68% to 80% (difference, 12%) in the intervention group vs. from 64% to 67% (difference, 3%) in the control group.
The absolute difference in the change between groups of was 9.1% (95% CI, 3.8–14.4) and the OR change in the use of oral anticoagulation between groups was 3.28 (95% CI 1.67–6.44), Vinereanu and colleagues wrote.
The Kaplan-Meier estimates of stroke showed a reduction in the intervention group vs. the control group (HR = 0.48; 95% CI, 0.23–0.99; log-rank P = .0434)
“The aggregate evidence shows that increased education, better communication between all stakeholders and feedback are needed to improve the use of anticoagulants to reduce the occurrence of stroke in AF,” Vinereanu and colleagues wrote. “Importantly, the interventions used in our study were simple and can be implemented in standard clinical practice, which has the potential to lead to better care of patients with AF around the world.”
In a related editorial comment, Michael D. Ezekowitz, MD, from Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, Lankenau Medical Center, Wynnewood, Pennsylvania, and Bryn Mawr Hospital, Bryn Mawr, Pennsylvania, and Anthony P. Kent, MD, from Bridgeport Hospital and Yale New Haven Health, wrote that use of anticoagulation in patients with AF is an example of “the suboptimal translation of scientific advances into clinical practice.
“IMPACT-AF emphasizes the need to educate patients, their families and their physicians about optimization of the management of stroke prevention in AF,” they wrote. “We are confident that the impact of IMPACT-AF will benefit patients with AF worldwide.”
The findings were also presented at the European Society of Cardiology Congress. – by Dave Quaile
Disclosure: Vinereanu reports receiving financial support from Abbott/Mylan, AstraZeneca, Bayer, Berlin Chemie Menarini, Boehringer Ingelheim, Bristol-Myers Squibb, Gedeon Richter, Johnson and Johnson, Novartis Pharma Services, Pfizer, Servier Pharma and Terapia. Please see the full study for a list of the other authors’ relevant financial disclosures. Ezekowitz reports consulting for Armetheon, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Pfizer and Portola and receiving grant support from Boehringer Ingelheim and Pfizer. Kent reports no relevant financial disclosures.
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