Education of healthcare professionals to improve guideline adherence in atrial fibrillation: the STEEER-AF cluster-randomized clinical trial

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Kotecha D.
  • Bunting K.V.
  • Mehta S.
  • Sommer P.
  • Sterlinski M.
  • Rajappan K.
  • Mont L.
  • Guasch E.
  • Boveda S.
  • Boriani G.
  • Sun Y.
  • van Deutekom C.
  • Gale C.P.
  • De Potter T.J.R.
  • van Gelder I.C.
  • Kirchhof P.
  • Raatikainen P.
  • Hatala R.
  • Banya W.
  • Lyon A.R.
  • Casadei B.
  • Pürerfellner H.
  • Price S.
  • Iung B.
  • Döhner W.
  • Heidbuchel H.
  • Qureshi N.
  • Bhuiyan A.H.
  • Finlay M.
  • Lovell M.J.
  • Kalla M.
  • Raine D.T.
  • Pedersen M.
  • Bates M.G.D.
  • Ng F.S.
  • Morais S.A.A.
  • Ang R.
  • Bond R.
  • Trucco E.
  • Cabanas-Grandío P.
  • Rivas-Gandara N.
  • Acosta J.
  • Fernández-Armenta J.
  • Calvo N.
  • Merino J.L.
  • Lozano T.
  • Anguera I.
  • Bisbal F.
  • Czerski T.
  • Gminski W.K.
  • Blicharz J.
  • Wilk-Manowiec H.
  • Gajda R.
  • Skrzynski A.S.
  • Sobieszek G.
  • Kostkiewicz M.
  • Gorlo A.
  • Gorzynska M.L.
  • Rapacciuolo A.
  • Fumagalli S.
  • Imberti J.F.
  • Bertini M.
  • Padeletti M.
  • Valzania C.
  • Mazza A.
  • Tilz R.R.
  • Nordbeck P.
  • Spitzer S.G.
  • Duncker D.
  • Shin D.-I.
  • Ebert H.-H.
  • Metzner A.
  • Borlich M.
  • Willems S.
  • Lellouche N.
  • Guenancia C.
  • Garnier F.
  • Hasni K.
  • Sacher F.
  • Gandjbakhch E.
  • Pavin D.
  • Maury P.
  • Garcia R.
  • Cianci A.
  • Anselme F.
  • De Guillebon M.
  • De Chillou C.
  • Escande W.
  • Piot O.
  • Davies M.J.
  • Sohaib A.
  • Thomas D.
  • Guerra J.M.
  • Luque I.R.
  • García-Izquierdo E.
  • Balsam P.
  • Buchta P.
  • Tubek S.
  • Russo V.
  • Diemberger I.
  • Proietti M.
  • Sinner M.F.
  • Rauch U.
  • Kochhaeuser S.
  • Baudinaud P.
  • Defaye P.
  • Marijon E.
  • Potpara T.
  • Robinson T.
  • Lobban T.
  • Stanbury M.
  • Ventura M.
  • Mobley A.
  • Laredo M.
  • Guy-Moyat B.
  • Greeley K.
  • Deneke T.
  • Champsi A.
  • Allali Y.

Grupos

Abstract

Guideline-adherent care is associated with better patient outcomes, but whether this can be achieved by professional education is unclear. Here we conducted a cluster-randomized controlled trial across 70 centers in six countries to understand if a program for the education of healthcare professionals could improve patient-level adherence to clinical practice guidelines on atrial fibrillation (AF). Each center recruited patients with AF seen in routine practice (total N = 1,732), after which the centers were randomized, accounting for baseline guideline adherence to class I and III recommendations from the European Society of Cardiology on stroke prevention and rhythm control. Healthcare professionals in the intervention centers received a 16-week structured educational program with an average of 9 h of online engagement, whereas those at control centers received no additional education beyond standard practice. For the co-primary stroke prevention outcome, guideline adherence was 63.4% and 58.6% at baseline and 67.5% and 60.9% at 6–9-months follow-up for the intervention and control groups, respectively (adjusted risk ratio 1.10; 95% confidence interval (CI) 0.97 to 1.24; P = 0.13). For the co-primary rhythm control outcome, guideline adherence was 21.4% and 20.4% at baseline and 33.9% and 22.9% at follow-up for the intervention and control groups, respectively (adjusted risk ratio 1.51; 95% CI 1.04 to 2.18; P = 0.03). The secondary outcome of patient-reported integrated AF management showed a 5.1% improvement in the intervention group compared with the control group (95% CI 1.4% to 8.9%; P = 0.01). Thus, while the education of healthcare professionals improved substantial gaps in implementation for rhythm control, it had no significant effect on stroke prevention. ClinicalTrials.gov registration: NCT04396418. © The Author(s) 2025.

Datos de la publicación

ISSN/ISSNe:
1078-8956, 1546-170X

NATURE MEDICINE  NATURE PORTFOLIO

Tipo:
Article
Páginas:
2647-2654
PubMed:
40514462
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
24,161 SCImago ℠
Cuartil:
Q1 SCImago ℠

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Keywords

  • Aged; Atrial Fibrillation; Female; Guideline Adherence; Health Personnel; Humans; Male; Middle Aged; Practice Guidelines as Topic; Stroke; anticoagulant therapy; Article; atrial fibrillation; cerebrovascular accident; clinical outcome; clinical practice guideline; controlled study; decision tree; electrocardiogram; engagement; European Quality of Life 5 Dimensions 5 Level questionnaire; follow up; France; Germany; health care personnel; heart rhythm; human; Italy; medical education; medical society; multicenter study; Poland; protocol compliance; quality of life; randomized controlled trial; sensitivity analysis; Spain; treatment outcome; vocational education; aged; clinical trial; education; female; male; middle aged; practice guideline; prevention and control; therapy

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