Publications

Background: Despite being a Class III recommendations, aspirin is still commonly used for stroke prevention in AF. We assessed the differential impact of a multifaceted educational intervention on OAC use in AF patients according to aspirin use at baseline.
Methods: This was a prespecified analysis of IMPACT-AF, a cluster-randomized trial of AF patients with indication for OAC. Clusters were 1:1 randomized to a multifaceted education intervention vs. usual care. We compared change in OAC use from baseline to 1 year in patients with and without aspirin at baseline.
Results: Of 2281 patients from 48 clusters in Argentina, Brazil, China, India, and Romania, 30% were on aspirin at baseline. Despite higher CHA2DS2-VASc score, aspirin-treated patients were less likely to be on OAC (35% vs. 79%) at baseline. OAC use increased from 42% to 62% in aspirin-treated patients in the intervention as compared with 29% to 36% in the control, whereas in patients not on aspirin, increased from 78% to 87% in the intervention and from 81% to 82% in the control (Table). After risk adjustment, the odds ratio of increase in OAC use between intervention vs control was 5.1(95% CI 2.1-12.3) for patients on aspirin and 1.8 (95% CI 1.1-3.0) for those not (p for interaction 0.01).
Conclusion: With a multifaceted educational intervention, patients on aspirin at baseline had significantly greater improvement in OAC use compared with those not, highlighting the opportunity to replace aspirin with OAC as an important goal to improve care of AF patients.