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

Vinereanu, Dragos ; Bahit, M Cecilia ; Xavier, Denis ; Jiang, Jie ; He, Wensheng ; Kamath, Deepak Y ; Pokorney, Sean D ; Tajer, Carlos ; Granger, Christopher B ; Carbajales, Justo ; Gómez, Javier Neri Ceferino ; Acunzo, Jorge Galperín Rafael Salvador ; Ciampi, Natalia ; Panigadi, Cristian Gustavo ; Pastura, Silvia Gabriela ; Onetto, Leonardo Martín ; Moya, Cecilia Rafaela ; Camerini, Daniel ; Medesani, Luis ; Ferroni, Fabián ; Fassi, Daniel Omar ; Bosio, Fernando Javier Díaz ; Baztarrica, Gabriel Edgardo Pérez ; Vico, Marisa Liliana ; Poy, Carlos Alberto ; Laspina, Marcela Julieta ; Poy, María Laura ; de Barros e Silva, Pedro Gabriel Melo ; Berwanger, Otavio ; Egydio, Flávia ; Restelli, Elissa ; Valois, Mayara Vioto ; Barbosa, Lilian Mazza ; Pimenta, Thiago Librelon ; Lemos, Maria Angelica Teixeira ; Costa, Osana Maria Coelho ; Demore, Ana Paula ; Brito, Roberta Parra ; Melo, Camila Dal Bon ; de Lima, Tiago Aparecido Maschio ; Rodrigues, Milena Pozzatto ; dos Santos, Tais Alves ; da Silveira Kaross, Níncia Lucca ; Cantarelli, Maiara ; do Amarante, Luciano ; Foscarini, Priscila ; Fialho, Lisa ; God, Epotamenides Maria Good ; Figueiredo, Estêvão Lanna ; Werner, Gustavo Fonseca ; de Faria Garcia, Jose Carlos ; Barbosa, Luiz Carlos Vianna ; Pardi, Ernaldo ; Oliveira, Márcia Domingos ; de Moraes, Michele Santos Montoni ; Filho, Adalberto Menezes Lorga ; Queirantes, Clotildes S.P. ; He, Pengkang ; Zhao, Mingzhong ; Yu, Juan ; Wang, Lijun ; Liu, Lili ; Liu, Shuwang ; Xia, Guangwei ; Wang, Zhirong ; Chen, Wensu ; Tang, Qiang ; Xu, Weiting ; Zhu, Xinyi ; Jin, Qiaoyun ; Xie, Xiaojie ; Thomas, Joby K. ; Rathi, Gaurav ; Doshi, Dhruval ; MA, Srilakshmi ; Kumar, Shantha ; Rao, Malipeddi Bhaskara ; Rao, Kodem Damodara ; Vuriya, Anjan Kumar ; Khandelwal, Bidita ; Khatri, Dheeraj ; Sharma, Mukesh ; Jathappa, Narendra ; Lokesh, B.H. ; Leela, A.C. ; Someshwara, K.C. ; Desai, Soaham ; Patel, Kunj ; Patel, Sujal ; Bhartiya, Maulik ; Mishra, Ashok Kumar ; Singh, Akansha ; Carstea, Nicolae ; Chitoiu, Gabriel Tatu ; Cornaciu, Stelian ; Gaita, Dan ; Pleava, Roxana ; Sinescu, Crina J. ; Magda, Stefania L. ; Matei, Lavinia

The Lancet (British edition), 2017-10, Vol.390 (10104), p.1737-1746 [Periódico revisado por pares]

England: Elsevier Ltd

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A multifaceted intervention to improve treatment with oral anticoagulants in atrial fibrillation (IMPACT-AF): an international, cluster-randomised trial
Autor: Vinereanu, Dragos ; Bahit, M Cecilia ; Xavier, Denis ; Jiang, Jie ; He, Wensheng ; Kamath, Deepak Y ; Pokorney, Sean D ; Tajer, Carlos ; Granger, Christopher B ; Carbajales, Justo ; Gómez, Javier Neri Ceferino ; Acunzo, Jorge Galperín Rafael Salvador ; Ciampi, Natalia ; Panigadi, Cristian Gustavo ; Pastura, Silvia Gabriela ; Onetto, Leonardo Martín ; Moya, Cecilia Rafaela ; Camerini, Daniel ; Medesani, Luis ; Ferroni, Fabián ; Fassi, Daniel Omar ; Bosio, Fernando Javier Díaz ; Baztarrica, Gabriel Edgardo Pérez ; Vico, Marisa Liliana ; Poy, Carlos Alberto ; Laspina, Marcela Julieta ; Poy, María Laura ; de Barros e Silva, Pedro Gabriel Melo ; Berwanger, Otavio ; Egydio, Flávia ; Restelli, Elissa ; Valois, Mayara Vioto ; Barbosa, Lilian Mazza ; Pimenta, Thiago Librelon ; Lemos, Maria Angelica Teixeira ; Costa, Osana Maria Coelho ; Demore, Ana Paula ; Brito, Roberta Parra ; Melo, Camila Dal Bon ; de Lima, Tiago Aparecido Maschio ; Rodrigues, Milena Pozzatto ; dos Santos, Tais Alves ; da Silveira Kaross, Níncia Lucca ; Cantarelli, Maiara ; do Amarante, Luciano ; Foscarini, Priscila ; Fialho, Lisa ; God, Epotamenides Maria Good ; Figueiredo, Estêvão Lanna ; Werner, Gustavo Fonseca ; de Faria Garcia, Jose Carlos ; Barbosa, Luiz Carlos Vianna ; Pardi, Ernaldo ; Oliveira, Márcia Domingos ; de Moraes, Michele Santos Montoni ; Filho, Adalberto Menezes Lorga ; Queirantes, Clotildes S.P. ; He, Pengkang ; Zhao, Mingzhong ; Yu, Juan ; Wang, Lijun ; Liu, Lili ; Liu, Shuwang ; Xia, Guangwei ; Wang, Zhirong ; Chen, Wensu ; Tang, Qiang ; Xu, Weiting ; Zhu, Xinyi ; Jin, Qiaoyun ; Xie, Xiaojie ; Thomas, Joby K. ; Rathi, Gaurav ; Doshi, Dhruval ; MA, Srilakshmi ; Kumar, Shantha ; Rao, Malipeddi Bhaskara ; Rao, Kodem Damodara ; Vuriya, Anjan Kumar ; Khandelwal, Bidita ; Khatri, Dheeraj ; Sharma, Mukesh ; Jathappa, Narendra ; Lokesh, B.H. ; Leela, A.C. ; Someshwara, K.C. ; Desai, Soaham ; Patel, Kunj ; Patel, Sujal ; Bhartiya, Maulik ; Mishra, Ashok Kumar ; Singh, Akansha ; Carstea, Nicolae ; Chitoiu, Gabriel Tatu ; Cornaciu, Stelian ; Gaita, Dan ; Pleava, Roxana ; Sinescu, Crina J. ; Magda, Stefania L. ; Matei, Lavinia
Assuntos: Administration, Oral ; Aged ; Anticoagulants ; Argentina - epidemiology ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - epidemiology ; Brazil - epidemiology ; Cardiac arrhythmia ; China - epidemiology ; Clinical outcomes ; Clinical trials ; Clusters ; Coagulation ; Data capture ; Drug therapy ; Drug Utilization - trends ; Education ; Education, Medical, Continuing ; Electrocardiography ; Embolisms ; Evidence-based medicine ; Feedback ; Female ; Fibrillation ; Health risks ; Heart attacks ; Hemorrhage - chemically induced ; Hemorrhage - epidemiology ; Humans ; Hypertension ; India - epidemiology ; Intervention ; Male ; Medication Adherence ; Middle Aged ; Patient education ; Patient Education as Topic ; Patients ; Prospective Studies ; Quality control ; Randomization ; Risk Factors ; Romania - epidemiology ; Stroke ; Stroke - epidemiology ; Stroke - prevention & control ; Systematic review
É parte de: The Lancet (British edition), 2017-10, Vol.390 (10104), p.1737-1746
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-News-2
ObjectType-Feature-3
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Descrição: 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. 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 ClinicalTrials.gov, number NCT02082548. 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). 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. Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, and Pfizer.
Editor: England: Elsevier Ltd
Idioma: Inglês

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

England: Elsevier Ltd

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