Sean Pokorney, MD: IMPACT-AFib and the Struggle to Improve Anticoagulant Adherence


Lead investigator of IMPACT-AFib discusses the results of the study and how they inform clinicians on strategies to improve oral anticoagulant use.

In what will come as a disappoint to many, results of IMPACT-AFib indicate an early education on stroke prevention did little to improve the rates of oral anticoagulant use among patients with atrial fibrillation and an indication for oral anticoagulant use.

Results of the study, which were presented at the European Society of Cardiology (ESC) Congress 2020, indicate an approach including patient- and provider-level educational intervention was not effective at increasing the proportion of patients using oral anticoagulant therapies.

“Among a population with a guideline indication for oral anticoagulant[s] for stroke prevention with atrial fibrillation, there was no statistically significant difference in rates of oral anticoagulant initiation at one year with a single education intervention,” said Sean Pokorney, MD, lead investigator and member of the Duke Clinical Research Institute, in a statement from the ESC.

In an effort to identify new methods of improving use of oral anticoagulants in patients with atrial fibrillation, Pokorney and a team of colleagues designed IMPACT-AFib to assess whether a patient- and provider-level intervention would improve use of oral anticoagulants in patients with a guideline-based indicated. For inclusion in the study, patients need to have a diagnosis of atrial fibrillation, a CHA2DS2-VASc score of 2 or greater, have no admission for bleeding 6 months prior to enrollment, not be prescribed an anticoagulant in the past 12 months, and be at least 30 years of age or older.

The primary outcome of the study was the difference in the proportion of patients using an oral anticoagulant over the course of the 12-month trial. The study also included multiple secondary end points such as proportion of days covered with an oral anticoagulant prescription, number of patients on an oral anticoagulant at the end of 1 year, and admissions for stroke or bleeding.

In total, the study enrolled more than 47,000 patients, but found the intervention failed to increase the proportion of patients using an oral anticoagulant during the trial. For more on the results of the trial and outcomes related to secondary end points, Practical Cardiology reached out to Pokorney to take part in a special edition ESC 2020 House Call.

This study, “IMPACT-AFib Implementation of Stroke Prevention in Atrial Fibrillation,” was presented ESC Congress 2020.

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