: 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 .
Education of healthcare professionals to improve guideline adherence in atrial fibrillation: the STEEER-AF cluster-randomized clinical trial / Kotecha, D.; Bunting, K. V.; Mehta, S.; Sommer, P.; Sterliński, 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.; Osca, J.; Lozano, T.; Anguera, I.; Bisbal, F.; Czerski, T.; Gmiński, W. K.; Blicharz, J.; Wilk-Manowiec, H.; Gajda, R.; Skrzyński, 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.. - In: NATURE MEDICINE. - ISSN 1078-8956. - 31:8(2025), pp. 2647-2654. [10.1038/s41591-025-03751-2]
Education of healthcare professionals to improve guideline adherence in atrial fibrillation: the STEEER-AF cluster-randomized clinical trial
Rapacciuolo A.;Willems S.;
2025
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 .I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
