STEEER-AF: Shockingly low adherence to ESC atrial fibrillation guidelines

Guideline adherence is remarkably poor among patients with atrial fibrillation (AF) across 6 European countries, an objective assessment of the STEEER-AF trial determined. Fortunately, a short online intervention for healthcare professionals was able to increase their patients’ adherence to rhythm control recommendations.

“Although we know that adherence to guidelines and patient education improve outcomes in patients with AF, we do not have solid evidence regarding the actual adherence to ESC Guidelines,” outlined Prof. Dipak Kotecha (University of Birmingham, UK) [1]. The STEEER-AF trial (NCT04396418), conducted by the ESC, assessed guideline adherence and tested an educational intervention to improve guideline adherence.

The investigators measured the adherence to class I and class III recommendations for stroke prevention and rhythm control among 1,732 patients with AF from France, Germany, Italy, Poland, Spain, and the UK. Additionally, 70 treatment centres were randomised 1:1 to an intervention group or a usual-care group. In the intervention group, the responsible healthcare professionals followed an online educational programme on improving patient adherence in the AF population.

Baseline adherence to all relevant class I and III ESC guideline recommendations were low for stroke prevention (61.0%) and abysmal for rhythm control (21.0%). On the bright side, the intervention was associated with a 51% increase in adherence to rhythm control guideline recommendations (21.4% to 33.9%), significantly outperforming the control arm (20.5% to 22.9%; adjusted risk ratio 1.51; 95% CI 1.04–2.18; P=0.03). For stroke prevention, the corresponding results in the intervention arm were 63.4% at baseline to 67.5% at follow-up; in the usual-care arm, the adherence rate went from 58.6% to 60.9% (adjusted risk ratio 1.10; 95% CI 0.97–1.24; P=0.13).

“The outcomes of this trial should be an eye-opener for the community,” argued Prof. Kotecha. “We have all these excellent trials with novel options to improve the outcomes for our patients. However, it is now demonstrated that the implementation is lacking. Without adherence, patients do not achieve their optimal outcomes,” emphasised Prof. Kotecha.

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   1. Kotecha D, et al. STEEER-AF: Stroke prevention and rhythm control therapy: evaluation of an educational programme of the ESC in a cluster-randomised trial in patients with atrial fibrillation. HOTLINE 6, ESC Congress 2024, 30 Aug–02 Sept, London, UK.

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Posted on 7 November 20247 November 2024