STRUCTURED ABSTRACT
Background Disparities in atrial fibrillation (AF) care are partially attributed to inadequate access to providers with specialized training in AF. Primary care providers (PCPs) are often the sole providers of AF care in under-resourced regions.
Objective To create a virtual education intervention for PCPs and evaluate its impact on use of stroke risk reduction strategies in AF patients.
Methods A multi-disciplinary team mentored PCPs on AF management over 6 months using a virtual case-based training format. Surveys of participant knowledge and confidence in AF care were compared pre- and post-intervention. Hierarchical logistic regression modeling was used to evaluate change in stroke risk reduction therapies among patients seen by participants before or after training.
Results Of 41 participants trained, 49% worked in family medicine, 41% internal medicine, and 10% general cardiology. Participants attended a mean of 14 one-hour sessions. Overall, appropriate use of oral anticoagulation (OAC) therapy (CHA2DS2-VASc score ≥1 men, ≥2 women) increased from 37% to 46% (p<.001) comparing patients seen pre- (n=1739) to post- (n=610) intervention. Factors independently associated with appropriate OAC use included participant training (OR 1.4, p=.002) and participant competence in AF management (by survey). Factors associated with decreased OAC use included patient age (OR 0.8 per 10 years, p=.008), nonwhite race (OR 0.7, p=.028). Provider knowledge and confidence in AF care both improved (p<.001).
Conclusions A virtual case-based PCP training intervention improved use of stroke risk reduction therapy in outpatients with AF. This widely scalable intervention could improve AF care in under-resourced communities.
CONDENSED ABSTRACT A virtual educational model was developed for primary care providers to improve competency in AF care in their community. Following a 6-month training intervention, the rate of appropriate oral anticoagulation (OAC) therapy among patients cared for by participating providers increased from 37% to 46% (p<.001). Among participants, knowledge and confidence in AF care improved. These findings suggest a virtual AF training intervention can improve PCP competency in AF care. This widely scalable intervention could help improve AF care in under-resourced communities.
Competing Interest Statement
The authors have declared no competing interest.
Clinical Trial
NA
Funding Statement
Support provided by an unrestricted grant from the Bristol Myers Squib Foundation
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The study received approval by the Institutional Review Board at the University of North Carolina at Chapel Hill.
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Yes
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Footnotes
Funding: Funding for this project was provided by the Bristol Myers Squib Foundation (New York, New York)
Disclosures: Dr. Gehi reports research funding from Bristol Myers Squib Foundation and consultancy fees / speaker’s honoraria from Abbott, Zoll Medical, iRhythm.
Dr. Sears serves as a consultant to Medtronic, Abbott, and Milestone Pharmaceutical. He has received speaker honorarium from Medtronic, Biotronik, and Zoll Medical in the past 12 months. Dr. Rosman’s effort was sponsored by a grant from the National Heart, Lung, and Blood Institute (K23HL141644). Dr. Rosman reports consultancy fees from Pfizer and Biotronik.
Jennifer Walker, ANP-BC reports research funding from Bristol Myers Squib Foundation. The remaining authors have nothing to disclose.
Data Availability
According to the Transparency and Openness Promotion (TOP) Guidelines, access to data collected for this study will be made available upon reasonable request sent to the corresponding author. Because of the sensitive nature of the data, access will be considered for qualified researchers trained in human subject confidentiality protocols.
ABBREVIATIONS
- AF
- Atrial fibrillation
- CME
- Continuing medical education
- ECHO
- Extension for community healthcare outcomes
- EKG
- Electrocardiogram
- MD
- Medical doctor
- NP
- Nurse practitioner
- OAC
- Oral anticoagulation
- PA
- Physician assistant
- SDI
- Social deprivation index