ESC 2020 Congress: IMPACT-AFib finds no statistical difference in anticoagulant usage

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Sean Pokorney

A study investigating an educational intervention aimed at increasing the use of oral anticoagulants for stroke prevention among atrial fibrillation (AF) patients, found that the intervention made no statistical difference in the uptake of oral anticoagulation. The findings of the IMPACT-AFib (IMplementation of an RCT to imProve Treatment With Oral AntiCoagulanTs in Patients With Atrial Fibrillation) were presented in a Hot Line session at ESC Congress 2020 (Virtual, 29 August–1 September) today.

Patients with atrial fibrillation are at increased risk of stroke, study author Sean Pokorney (Duke University, Durham, USA) explained. Studies have shown that most of these strokes can be prevented with oral anticoagulation, however, oral anticoagulant medication is underused by patients with AF.

The IMPACT-AFib trial investigated whether education on stroke prevention in AF for patients and their healthcare providers could increase the use of oral anticoagulants. The primary endpoint was the proportion of patients started on oral anticoagulation over the course of the 12-month trial.

The trial enrolled AF patients aged 30 years and older with a guideline-based indication for oral anticoagulation (defined as a CHA₂DS₂-VASc score of 2 or greater). Participants had not been prescribed an anticoagulant in the prior 12 months, and had not been admitted to hospital for bleeding in the prior six months.

Patients were randomly allocated to the educational intervention or usual care (control group). In the intervention group, patients and their healthcare providers received one mailing at the start of the trial.

A total of 47,333 patients were included in the analysis. The average age of participants was 78 years. At one year, the primary endpoint occurred in 2,328 patients (9.89%) in the intervention group and 2,330 patients (9.80%) in the control group. The adjusted odds ratio was 1.01 (95% confidence interval 0.95–1.07).

Commenting on the results, Pokorney said: “Among a population with a guideline indication for oral anticoagulants for stroke prevention with atrial fibrillation, there was no statistically significant difference in rates of oral anticoagulant initiation at one year with a single education intervention.”

Pokorney said: “Numerically more patients initiated oral anticoagulants early after [the]mailing, raising the question of whether multiple mailings or further contact may have been beneficial.”


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