IMProve treatment with AntiCoagulanTs in patients with Atrial Fibrillation - IMPACT-AF

Contribution To Literature:

The IMPACT-AF trial showed that an educational intervention was superior at improving the use of oral anticoagulation therapy.

Description:

The goal of the trial was to evaluate an educational intervention compared with usual care among patients with atrial fibrillation.

Study Design

  • Randomized
  • Parallel

Patients with atrial fibrillation and an indication for anticoagulation were randomized to a multifaceted and multilevel educational intervention (n = 1,187) versus usual care (n = 1,094).

  • Total number of enrollees: 2,281
  • Duration of follow-up: 12 months
  • Mean patient age: 70 years
  • Percentage female: 48%
  • Percentage with diabetes: 25%

Inclusion criteria:

  • Presence of atrial fibrillation and indication for anticoagulation therapy (CHA2DS2-VASc score ≥2)

Exclusion criteria:

  • Mechanical prosthetic valve
  • Clinically unstable
  • Life expectancy <6 months or unable to provide consent
  • Contraindication to oral anticoagulation

Principal Findings:

The primary outcome, change in the proportion of patients treated with oral anticoagulants from baseline to 1 year, was 12% in the educational group versus 3% in the control group (p = 0.0002).

Secondary outcomes:

  • Deaths: 5% in the educational group vs. 5% in the control group (p = 0.88)
  • Strokes: 1% in the educational group vs. 2% in the control group (p = 0.043)
  • Clinically relevant nonmajor bleeding: 3% in the educational group vs. 3% in the control group (p = 0.43)

Interpretation:

Among patients with atrial fibrillation, the use of an educational intervention increased the proportion of patients treated with oral anticoagulation therapy. Although not powered for clinical events, the educational group was associated with a reduction in total strokes. This educational program needs to be considered as a mechanism to increase the use of oral anticoagulation therapy.

References:

Vinereanu D, Lopes RD, Bahit MC, et al., on behalf of the IMPACT-AF Investigators. A multifaceted intervention to improve treatment with oral anticoagulants in atrial fibrillation (IMPACT-AF): an international, cluster-randomised trial. Lancet 2017;390:1737-46.

Editorial Comment: Ezekowitz MD, Kent AP. The Impact of IMPACT-AF. Lancet 2017;390:1717-8.

Presented by Dr. Christopher B. Granger at the European Society of Cardiology Congress, Barcelona, Spain, August 28, 2017.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Early Intervention (Education), ESC Congress, ESC2017, Hemorrhage, Secondary Prevention, Stroke, Treatment Outcome


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