Education of healthcare professionals to improve guideline adherence in atrial fibrillation: the STEEER-AF cluster-randomized clinical trial
Kotecha, Dipak Bunting, Karina V Mehta, Samir Sommer, Philipp Sterliński, Maciej Rajappan, Kim Mont, Lluís Guasch, Eduard Boveda, Serge Boriani, Giuseppe
Kotecha, Dipak
Bunting, Karina V
Mehta, Samir
Sommer, Philipp
Sterliński, Maciej
Rajappan, Kim
Mont, Lluís
Guasch, Eduard
Boveda, Serge
Boriani, Giuseppe
Affiliation
University of Birmingham; University Hospitals Birmingham NHS Foundation Trust; NIHR Birmingham Biomedical Research Centre; Institute of Applied Health Research; Heart and Diabetes Center North Rhine-Westphalia; Polish National Institute of Cardiology; Oxford University Hospitals NHS Foundation Trust; Universitat de Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer; Centro de Investigación Médica en Red-Enfermedades Cardiovasculares; Clinique Pasteur; Vrije Universiteit Brussels; University of Modena and Reggio Emilia; Policlinico di Modena; University of Groningen; University Medical Centre Groningen; University of Leeds; Leeds Teaching Hospitals; Cardiovascular Center Aalst
Other Contributors
Allali, Yann
Champsi, Asgher
Deneke, Thomas
Greeley, Kaitlyn
Guy-Morat, Benoit
Robinson, Thompson
Potpara, Tatjana
Marijon, Eloi
Defaye, Pascal
Baudinaud, Pierre
Kochhaeuser, Simon
Rauch, Ursula
Sinner, Moritz F
Proietti, Marco
Diemberger, Igor
Russo, Vincenzo
Tubek, Stanislaw
Buchta, Piotr
Balsam, Pawel
Garcia-Izquierdo, Eusebio
Roca Luque, Ivo
Guerra, Jose M
Thomas, Dewi
Sohaib, Afzal
Davies, Mark J
Piot, Olivier
Escande, William
De Chillou, Christian
De Guillebon, Maxime
Anselme, Frederic
Cianci, Andrea
Garcia , Rodrigue
Maury, Philippe
Pavin, Dominique
Gandjbakhch, Estelle
Sacher, Frederic
Hasni, Karim
Garnier, Fabien
Guenancia, Charles
Lellouche, Nicolas
Willems, Stephan
Borlich, Martin
Metzner, Andreas
Ebert, Hans-Holger
Shin, Dong-In
Duncker, David
Spitzer, Stefan G
Nordbeck, Peter
Tilz, Roland R
Mazza, Andrea
Valzania, Cinzia
Padeletti, Margherita
Bertini, Matteo
Imberti, Jacopo F
Fumagalli, Stefano
Rapacciuolo, Antonio
Gorzynska, Monika Lica
Gorlo, Adam
Kostkiewicz, Marcin
Sobieszek, Grzegorz
Skrzynski, Andrzej S
Gajda, Robert
Wilk-Manowiec, Hanna
Blicharz, Jaroslaw
Gminski, Wiktor K
Czerski, Tomasz
Bisbal, Felipe
Anguera, Ignasi
Lozano, Teresa
Osca, Joaquin
Merino, Jose L
Calvo, Naiara
Fernandez-Armenta, Juan
Acosta, Juan
Rivas-Gandara, Nuria
Cabanas-Grandio, Pilar
Trucco, Emilce
Bond, Richard
Ang, Richard
Morais, Shawn A A
Ng, Fu Siong
Bates, Matthew G D
Pedersen, Michala
Raine, Daniel T
Kalla, Manish
Lovell, Matthew J
Finlabhuiyany, Arif Hasan
Qureshi, Norman
Heidbuchel, Hein
Dohner, Wolfram
Iung, Bernard
Price, Susanna
Purerfellner, Helmut
Casadei, Barbara
Lyon, Alex R
Banya, Winston
Hatala, Robert
Raatikainen, Pekka
Kirchhof, Paulus
Champsi, Asgher
Deneke, Thomas
Greeley, Kaitlyn
Guy-Morat, Benoit
Robinson, Thompson
Potpara, Tatjana
Marijon, Eloi
Defaye, Pascal
Baudinaud, Pierre
Kochhaeuser, Simon
Rauch, Ursula
Sinner, Moritz F
Proietti, Marco
Diemberger, Igor
Russo, Vincenzo
Tubek, Stanislaw
Buchta, Piotr
Balsam, Pawel
Garcia-Izquierdo, Eusebio
Roca Luque, Ivo
Guerra, Jose M
Thomas, Dewi
Sohaib, Afzal
Davies, Mark J
Piot, Olivier
Escande, William
De Chillou, Christian
De Guillebon, Maxime
Anselme, Frederic
Cianci, Andrea
Garcia , Rodrigue
Maury, Philippe
Pavin, Dominique
Gandjbakhch, Estelle
Sacher, Frederic
Hasni, Karim
Garnier, Fabien
Guenancia, Charles
Lellouche, Nicolas
Willems, Stephan
Borlich, Martin
Metzner, Andreas
Ebert, Hans-Holger
Shin, Dong-In
Duncker, David
Spitzer, Stefan G
Nordbeck, Peter
Tilz, Roland R
Mazza, Andrea
Valzania, Cinzia
Padeletti, Margherita
Bertini, Matteo
Imberti, Jacopo F
Fumagalli, Stefano
Rapacciuolo, Antonio
Gorzynska, Monika Lica
Gorlo, Adam
Kostkiewicz, Marcin
Sobieszek, Grzegorz
Skrzynski, Andrzej S
Gajda, Robert
Wilk-Manowiec, Hanna
Blicharz, Jaroslaw
Gminski, Wiktor K
Czerski, Tomasz
Bisbal, Felipe
Anguera, Ignasi
Lozano, Teresa
Osca, Joaquin
Merino, Jose L
Calvo, Naiara
Fernandez-Armenta, Juan
Acosta, Juan
Rivas-Gandara, Nuria
Cabanas-Grandio, Pilar
Trucco, Emilce
Bond, Richard
Ang, Richard
Morais, Shawn A A
Ng, Fu Siong
Bates, Matthew G D
Pedersen, Michala
Raine, Daniel T
Kalla, Manish
Lovell, Matthew J
Finlabhuiyany, Arif Hasan
Qureshi, Norman
Heidbuchel, Hein
Dohner, Wolfram
Iung, Bernard
Price, Susanna
Purerfellner, Helmut
Casadei, Barbara
Lyon, Alex R
Banya, Winston
Hatala, Robert
Raatikainen, Pekka
Kirchhof, Paulus
Publication date
2025-06-13
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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.
Citation
Kotecha D, Bunting KV, Mehta S, Sommer P, Sterliński M, Rajappan K, Mont L, Guasch E, Boveda S, Boriani G, Sun Y, van Deutekom C, Gale CP, De Potter TJR, van Gelder IC; STEEER-AF investigators. Education of healthcare professionals to improve guideline adherence in atrial fibrillation: the STEEER-AF cluster-randomized clinical trial. Nat Med. 2025 Aug;31(8):2647-2654. doi: 10.1038/s41591-025-03751-2. Epub 2025 Jun 13.
Type
Article