Abstract
BackgroundSuboptimal uptake of anticoagulation for stroke prevention in atrial fibrillation has persisted for over 20 years, despite high-level evidence demonstrating its effectiveness in reducing the risk of fatal and disabling stroke.MethodsThe STOP STROKE in AF study is a national, cluster randomised controlled trial designed to improve the uptake of anticoagulation in primary care. General practitioners from around Australia enrolling in this ‘distance education’ program are mailed written educational materials, followed by an academic detailing session delivered via telephone by a medical peer, during which participants discuss patient de-identified cases. General practitioners are then randomised to receive written specialist feedback about the patient de-identified cases either before or after completing a three-month posttest audit. Specialist feedback is designed to provide participants with support and confidence to prescribe anticoagulation. The primary outcome is the proportion of patients with atrial fibrillation receiving oral anticoagulation at the time of the posttest audit.DiscussionThe STOP STROKE in AF study aims to evaluate a feasible intervention via distance education to prevent avoidable stroke due to atrial fibrillation. It provides a systematic test of augmenting academic detailing with expert feedback about patient management.Trial registrationAustralian Clinical Trials Registry Registration Number: ACTRN12611000076976.
Highlights
Suboptimal uptake of anticoagulation for stroke prevention in atrial fibrillation has persisted for over 20 years, despite high-level evidence demonstrating its effectiveness in reducing the risk of fatal and disabling stroke
Long-term anticoagulation for Atrial fibrillation (AF) remains the treatment of choice to prevent stroke in most people with AF
The addition of expert decisional support in our intervention arms allows for a direct test of this component on general practitioners (GPs) self-reported patient management
Summary
Please see attached file (Additional file 1) for the study flow diagram. GP recruitment We obtained contact details of GPs from a commercially available database [36], which sources information from professional colleges, medical directories, and state medical boards that register all practising clinicians in Australia. Appropriate antithrombotic treatment according to stroke risk incorporating quality-control criteria In those patients receiving anticoagulation with warfarin, we will only consider anticoagulation to be appropriate for this outcome if GPs, when reporting the six most recent INR results, report an INR result at least monthly and where at least four of the six test results (or twothirds of results in cases where fewer than six are reported) are within therapeutic range (i.e., within 2.0– 3.0) These criteria for appropriate anticoagulation are based on local guidelines [44] and a consistently achieved standard of ‘time in therapeutic range’ reported in clinical trials [4,5,6], including one trial of general practice patients with an average age of 81 years [6]. Ethics approval The Human Research Ethics Committee of the University of New South Wales has approved the study (UNSW HREC Reference Number 07067)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
