A targeted educational intervention increases oral anticoagulation rates in high-risk atrial fibrillation patients

Abstract

BackgroundAnticoagulation is the cornerstone of atrial fibrillation (AF) management for stroke prevention. Recently, we showed that AF patients’ oral anticoagulation (OAC) rates in a large US multispecialty health system are above 80%. ObjectiveThis study sought to improve OAC rates in AF patients via an educational intervention targeted to primary care providers with low OAC rates. MethodsPrimary care clinicians were stratified by proportions of their AF patients at elevated stroke risk not on anticoagulation medication. Clinicians with the lowest rates of anticoagulation were assigned to a target group receiving an educational program consisting of e-mail messaging summarizing anticoagulation guidelines. All other clinicians were assigned to a comparison group. Data from a six-month lead-in phase were compared with a six-month follow-up period to determine if the proportion of AF patients treated with OACs had changed. ResultsThere were 141 primary care clinicians with patients who met the inclusion criteria, with 36 (25.53%) assigned to the educational intervention (EG) and 105 (74.47%) assigned to the comparison group (CG). At baseline there was a significant difference in percent of high-risk AF patients who were untreated in the EG (20.65%) as compared to the high-risk patients who were untreated in the CG (13.64%, p=0.001). After the educational intervention, high-risk AF patients without anticoagulation decreased in both EG (15.47% p=0.047) and CG (10.14% p=0.07) with greater absolute reduction in the EG (5.19% versus 3.50%). ConclusionA targeted education program was associated with increased anticoagulation rates for AF patients at high risk of stroke.