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A multifaceted intervention to improve treatment with oral anticoagulants in atrial fibrillation (IMPACT-AF): an international, cluster-randomised trial

Mostrar el registro sencillo del ítem Vinereanu, Dragos Lopes, Renato Bahit, Cecilia Xavier, Denis Jiang, Jie Al-Khalidi, Hussein R He, Wensheng Xian, Ying Ciobanu, Andrea O Kamath, Deepak Y Fox, Kathleen A Rao, Meena P Pokorney, Sean D Berwanger, Otavio Tajer, Carlos de Barros e Silva, Pedro Roettig, Mayme L Huo, Yong Granger, Christopher B Carbajales, Justo Gómez, Javier Neri Ceferino Principato, Mario Bruno Von Wulffen, María Alejandra Acunzo, Jorge Galperín Rafael Salvador Bonato, Ricardo Renato Ciampi, Natalia Marani, Alberto Babil Panigadi, Cristian Gustavo Pastura, Silvia Gabriela Onetto, Leonardo Martín IMPACT-AF investigators 2019-03-12T18:42:22Z 2019-03-12T18:42:22Z 2017
dc.identifier.issn 0140-6736
dc.identifier.other 10.1016/S0140-6736(17)32165-7
dc.description Fil: Tajer, C. Hospital de Alta Complejidad en Red El Cruce Dr. Néstor C. Kirchner. Servicio de Cardiología. Florencio Varela, Argentina. es_AR
dc.description.abstract BACKGROUND: Oral anticoagulation is underused in patients with atrial fibrillation. We assessed the impact of a multifaceted educational intervention, versus usual care, on oral anticoagulant use in patients with atrial fibrillation. METHODS: This study was a two-arm, prospective, international, cluster-randomised, controlled trial. Patients were included who had atrial fibrillation and an indication for oral anticoagulation. Clusters were randomised (1:1) to receive a quality improvement educational intervention (intervention group) or usual care (control group). Randomisation was carried out centrally, using the eClinicalOS electronic data capture system. The intervention involved education of providers and patients, with regular monitoring and feedback. The primary outcome was the change in the proportion of patients treated with oral anticoagulants from baseline assessment to evaluation at 1 year. The trial is registered at, number NCT02082548. FINDINGS: 2281 patients from five countries (Argentina, n=343; Brazil, n=360; China, n=586; India, n=493; and Romania, n=499) were enrolled from 48 clusters between June 11, 2014, and Nov 13, 2016. Follow-up was at a median of 12·0 months (IQR 11·8-12·2). Oral anticoagulant use increased in the intervention group from 68% (804 of 1184 patients) at baseline to 80% (943 of 1184 patients) at 1 year (difference 12%), whereas in the control group it increased from 64% (703 of 1092 patients) at baseline to 67% (732 of 1092 patients) at 1 year (difference 3%). Absolute difference in the change between groups was 9·1% (95% CI 3·8-14·4); odds ratio of change in the use of oral anticoagulation between groups was 3·28 (95% CI 1·67-6·44; adjusted p value=0·0002). Kaplan-Meier estimates showed a reduction in the secondary outcome of stroke in the intervention versus control groups (HR 0·48, 95% CI 0·23-0·99; log-rank p value=0·0434). INTERPRETATION: A multifaceted and multilevel educational intervention, aimed to improve use of oral anticoagulation in patients with atrial fibrillation and at risk for stroke, resulted in a significant increase in the proportion of patients treated with oral anticoagulants. Such an intervention has the potential to improve stroke prevention around the world for patients with atrial fibrillation. es_AR
dc.description.sponsorship FUNDING: Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, and Pfizer. es_AR
dc.language.iso en_US es_AR
dc.subject Estudios Clínicos como Asunto es_AR
dc.subject Análisis por Conglomerados es_AR
dc.subject Fibrilación Atrial es_AR
dc.subject Arritmias Cardíacas es_AR
dc.subject Anticoagulantes es_AR
dc.title A multifaceted intervention to improve treatment with oral anticoagulants in atrial fibrillation (IMPACT-AF): an international, cluster-randomised trial es_AR
dc.type Article es_AR

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