A single educational mailing on stroke prevention for atrial fibrillation (AFib) patients and their clinicians did not increase the use of oral anticoagulants, according to results of the IMPACT-AFib trial presented during ESC Congress 2020.

Researchers randomly assigned 47,333 AFib patients (average age of 78 years) with a guideline-based indication for oral anticoagulation (defined as a CHA₂DS₂-VASc score of 2 or greater) to receive either an educational intervention (one mailing at the start of the trial) or usual care. 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. The primary endpoint was the proportion of patients started on oral anticoagulation over the course of the 12-month trial.

Researchers found that 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 usual care group. The adjusted odds ratio was 1.01 (95% confidence interval 0.95–1.07).

"Among a population with a guideline indication for oral anticoagulant[s] for stroke prevention with AFib, there was no statistically significant difference in rates of oral anticoagulant initiation at one year with a single education intervention," said study author Sean Pokorney, MD, of Duke University, Durham, NC. However, he noted that "numerically more patients initiated oral anticoagulants early after the mailing, raising the question of whether multiple mailings or further contact may have been beneficial." He added that "additional trials are needed to assess feasibility of patient consent and repeat patient interactions."

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

Keywords: ESC Congress, ESC20, Atrial Fibrillation, Stroke, Arrhythmias, Cardiac

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