Nav: Home

Education and feedback improve use of stroke prevention drugs in AF (IMPACT-AF)

August 28, 2017

Barcelona, Spain - 28 Aug 2017: Education of healthcare providers and patients with atrial fibrillation has led to a 9% absolute increase in the use of anticoagulation therapies to reduce stroke, according to late-breaking results from the IMPACT-AF trial presented today in a Hot Line LBCT Session at ESC Congress1 and published in the Lancet.

This corresponds to a more than three-fold increase in anticoagulation use from baseline to one year in the intervention group, compared with the control group. The increased drug use was accompanied by a modest, but notable, reduction in the risk of stroke.

"More than 33 million people worldwide have atrial fibrillation, which is a leading cause of stroke," said principal investigator Prof Christopher Granger, professor of medicine at Duke Clinical Research Institute, Durham, US.

"Only about half of patients with atrial fibrillation take anticoagulant drugs, despite these medications being highly effective in preventing strokes," he continued. "Increasing the use of anticoagulation therapies has the potential to prevent hundreds of thousands of strokes each year."

The IMPACT-AF trial2 assessed whether education of providers and patients with atrial fibrillation, with monitoring and feedback, could increase the use of oral anticoagulation compared to usual care. The trial included 2 281 patients with atrial fibrillation from 48 centres in Argentina, Brazil, China, India and Romania. In each country, centres were randomised in a 1:1 ratio to receive an educational intervention (intervention group) or usual care (control group) for one year.

The educational intervention was customised to each country and explained the benefits of anticoagulant therapies, as well as the risks and costs. Patients were given brochures and shown videos, and then monitored at doctor visits to get their feedback and learn of any problems that kept them from staying on the medication. Physicians received information and reports from the researchers through emails, articles, webinars and podcasts. The primary outcome was the change in the proportion of patients treated with oral anticoagulation at one year.

At one year, the overall use of anticoagulation therapies had risen by 11.7% in the intervention group and 2.6% in the control group (p = 0.0002). When the researchers looked only at patients not treated with any anticoagulation therapy at the start of the study, they found that 48% of those in the intervention group were on an anticoagulant at one year compared to only 18% in the control group (p < 0.0001).

Prof Granger said: "The trial shows that education and monitoring are effective ways to improve adherence to oral anticoagulation medication in patients with atrial fibrillation. If this intervention was broadly applied, which we believe is possible, the public health implications could be substantial."

The researchers also found that during the follow-up, 1.0% of patients in the intervention group had a stroke compared to 2.0% of patients in the control group, corresponding to a 52% reduction (p = 0.04). In fact, the number needed to treat (NNT) was 100 patients exposed to intervention to prevent one stroke event over a one-year period.

"We observed a reduction in strokes in the intervention compared to the control group," said Prof Dragos Vinereanu, professor of cardiology at the University of Medicine and Pharmacy Carol Davila, Bucharest, Romania and the principal investigator for Romania. "Stroke reduction is the ultimate goal, and this finding shows the potential benefit of improving anticoagulation care."

Prof Granger pointed out that a limitation of the cluster randomisation design, in which centres (rather than individual patients) are assigned to the intervention or control arm, was that baseline use of anticoagulants may have been overestimated in the control sites.

He concluded: "Additional studies are needed to better understand why such a large proportion of patients with atrial fibrillation discontinue, or never even start, oral anticoagulation therapy."
-end-


European Society of Cardiology

Related Stroke Articles:

How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.
Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.
High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.
Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.
We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.
Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.
Stroke affects more than just the physical
A new study looks at what problems affect people most after a stroke and it provides a broader picture than what some may usually expect to see.
Stroke journal features women's studies on how gender influences stroke risk, treatment and outcomes
Many aspects of strokes affect women and men differently, and four articles in the American Heart Association's journal Stroke highlight recent research and identify future research needs.
Too few with stroke of the eye are treated to reduce future stroke
Only one-third of 5,600 patients with retinal infarction, or stroke in the eye, underwent basic stroke work-up, and fewer than one in 10 were seen by a neurologist.
Juvenile stroke: Causes often not known
Strokes without a definitive identifiable cause account for up to 50 percent of juvenile strokes.
More Stroke News and Stroke Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#538 Nobels and Astrophysics
This week we start with this year's physics Nobel Prize awarded to Jim Peebles, Michel Mayor, and Didier Queloz and finish with a discussion of the Nobel Prizes as a way to award and highlight important science. Are they still relevant? When science breakthroughs are built on the backs of hundreds -- and sometimes thousands -- of people's hard work, how do you pick just three to highlight? Join host Rachelle Saunders and astrophysicist, author, and science communicator Ethan Siegel for their chat about astrophysics and Nobel Prizes.