Abstract

Introduction: The ability of virtual patient simulation (VPS) case-based interventions to improve clinical decision making for patients with atrial fibrillation (AF) is unknown. Methods: Two patient cases were presented using a VPS platform where learners could order tests, make diagnoses, and order treatments in a manner matching the scope and depth of actual practice. Clinical decisions were analyzed, and learners received clinical guidance (CG) based on current evidence and expert recommendations. Learners could modify their decisions post-CG. Pre-(baseline) vs. post-CG decisions were compared using McNemar’s test. The intervention launched in August, 2022 and data were collected through December, 2022. Results: Overall, 1599 physicians participated. Physician specialties included cardiology (65%) and primary care physicians (35%). Significant improvements were seen for appropriate, timely diagnosis of AF and treatment selection in the overall learner population; treatment improvements were greatest for tailoring anti-arrhythmic drug (AAD) therapy in patients with recently diagnosed AF ( Table ). Improvements in selection of appropriate anti-arrhythmic drug (AAD) was observed for all specialties, although specialty-specific differences were apparent ( Table ). Significant improvements were also observed for selection of appropriate monitoring strategies to determine response to treatment and reaching treatment goals ( Table ). Conclusion: Case-based AF intervention employing VPS was associated with improvements in diagnostic and therapeutic decision-making among cardiologists and PCPs. Despite the observed improvements, gaps remain in diagnosing and selecting appropriate rhythm control management strategies for patients with AF.

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