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Drug initiation strategy not associated with increased use of oral anticoagulants

Presented by
Prof. Sean Pokorney , Duke University, USA
ESC 2020
IMPACT-AFib trial
The IMPACT-AFib trial found that a single educational mailing to atrial fibrillation (AF) patients and their healthcare providers did not increase uptake of oral anticoagulant at 1 year compared with usual care [1].

Prof. Sean Pokorney (Duke University, USA) presented the IMPACT-AFib trial, a prospective, randomised, educational intervention trial. The trial assessed whether early education on stroke prevention in AF for patients and their healthcare providers could increase the use of oral anticoagulants.

A total of 47,333 AF patients (average age of 78 years) who had an indication for oral anticoagulation, defined as a CHA₂DS₂-VASc score of ≥2, randomly received either an early educational intervention (i.e. one mailing at the start of the trial) or a delayed educational intervention (i.e. usual care). Participants had not been prescribed an anticoagulant in the prior 12 months and had not been admitted to hospital for bleeding in the prior 6 months.

The primary endpoint, the proportion of patients starting on oral anticoagulation during the 12-month follow-up period, occurred in 9.89% of patients in the intervention group and in 9.80% in the usual care group (adjusted odds ratio 1.01).

However, numerically more patients initiated oral anticoagulants early after the mailing. This raises the question whether multiple mailings or further contact could be beneficial. Additional trials are needed to assess feasibility of patient consent and repeat patient interactions.


    1. Pokorney S. IMPACT-Afib Implementation of Stroke Prevention in Atrial Fibrillation. Hot Line 4 session, ESC Congress 2020, 31 Aug.


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