In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

Educational mailing fails to improve medication use in patients with atrial fibrillation

IMPACT-AFib trial presented in a Hot Line Session today at ESC Congress 2020


Sophia Antipolis, France – 1 Sept 2020:  An educational mailing for atrial fibrillation patients and their clinicians did not increase uptake of stroke prevention drugs, according to results of the IMPACT-AFib trial presented in a Hot Line session today at ESC Congress 2020.1

Patients with atrial fibrillation are at increased risk of stroke. Studies have shown that most of these strokes can be prevented with oral anticoagulation.2,3 However, oral anticoagulant medication is underused by patients with atrial fibrillation.

The IMPACT-AFib trial investigated whether education on stroke prevention in atrial fibrillation for patients and their healthcare providers could increase the use of oral anticoagulants.

The primary endpoint was the proportion of patients started on oral anticoagulation over the course of the 12-month trial.

The trial enrolled atrial fibrillation patients aged 30 years and older with a guideline-based indication for oral anticoagulation (defined as a CHA₂DS₂-VASc score of 2 or greater).4 Participants had not been prescribed an anticoagulant in the prior 12 months, and had not been admitted to hospital for bleeding in the prior six months.

Patients were randomly allocated to the educational intervention or usual care (control group). In the intervention group, patients and their healthcare providers received one mailing at the start of the trial.

A total of 47,333 patients were included in the analysis. The average age of participants was 78 years. At one year, the primary endpoint occurred in 2,328 patients (9.89%) in the intervention group and 2,330 patients (9.80%) in the control group. The adjusted odds ratio was 1.01 (95% confidence interval 0.95–1.07).

Study author Dr. Sean Pokorney of Duke University, Durham, US said: “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.”

Dr. Pokorney said: “Numerically more patients initiated oral anticoagulants early after [the] mailing, raising the question of whether multiple mailings or further contact may have been beneficial.”



Notes to editor

Authors: ESC Press Office

Mobile: +33 (0)7 85 31 20 36

The hashtag for ESC Congress 2020 is #ESCCongress.

Follow us on Twitter @ESCardioNews 

This press release accompanies both a presentation and an ESC press conference at ESC Congress 2020 – The Digital Experience. It does not necessarily reflect the opinion of the European Society of Cardiology.


Funding: The US Food and Drug Administration (FDA) provided all funding.

Disclosures: not provided.

References and notes

1Abstract title: IMplementation of a randomized controlled trial to imProve treatment with oral AntiCoagulanTs in patients with Atrial Fibrillation.

2Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146:857–867.

3Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383:955–962.

4CHA2DS2-VASc: Congestive Heart failure, hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled), Vascular disease, Age 65–74, and Sex (female).


About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress

ESC Congress is the world’s largest gathering of cardiovascular professionals contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2020 takes place online from 29 August to 1 September. More information is available from the ESC Press Office at