Abstract 9033: Effectiveness of a Virtual Patient Simulation at Improving Management of Complex Patients with Arterial Disease

Abstract

Introduction: Despite evidence and guidelines for management of patients with arterial disease, including CAD and PAD, patients remain at high risk for adverse cardiac events. Cardiologists are challenged to implement the latest evidence-based strategies to reduce risk for adverse cardiovascular events in these patients. We sought to determine if an online, virtual patient simulation (VPS)-based continuing medical education intervention could improve performance of cardiologists related to implementation of effective antithrombotic strategies to improvement management of patients with CAD and PAD. Methods: The intervention comprised two patients presenting in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision, followed by the opportunity for the learner to modify their decisions. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a McNemar’s test to determine P values. Data were collected July 30-November 10, 2020. Results: Significant absolute improvements were observed after CG for the following: Case 1 (n= 152) Order/Initiate: Screening for high-risk categorization using modified REACH score: 15% improvement (24% pre-CG vs 39% post-CG; P<.001); Evaluate for bleeding risk: 20% improvement (25% pre-CG vs 46% post-CG; P<.001); Rivaroxaban: 55% improvement (0% pre-CG vs 55% post-CG; P<.001); Continue aspirin: 1% improvement (86% pre-CG vs 87% post-CG, P=ns); Follow-up visits: 14% improvement (41% pre-CG vs 55% post-CG; P<.001) Case 2 (n= 113) Order/Initiate: ABI: 44% improvement (1% pre-CG vs 45% post-CG; P<.001); Rivaroxaban: 55% improvement (0% pre-CG vs 55% post-CG; P<.001); Continue aspirin: 7% improvement (81% pre-CG vs 88% post-CG, P<.05); Follow-up visits: 17% improvement (50% pre-CG vs 67% post-CG; P<.001) Conclusions: VPS that immerses and engages specialists in an authentic, patient-based, practical learning environment can significantly improve evidence-based clinical decision making for the management of complex arterial disease.