Simulation-based course does not increase oral anticoagulants in hospitalized elderly AF patients

A simulation-based education for physicians has failed to improve the rate of elderly patients with atrial fibrillation (AF) prescribed with oral anticoagulants (OACs) at hospital discharge relative to the usual practice, a study has shown.

Nevertheless, there has been an increase in the number of patients prescribed with OACs and direct (D)OACs in the intervention than in the control arm.

A total of 452 patients were identified, of whom 247 were included in the analysis. OACs were prescribed in 186 (75.3 percent) patients at hospital discharge.

In the postintervention phase, there was no difference seen between the intervention and control arms (odds ratio, 1.46, 95 percent CI, 0.81–2.64).

However, the intervention arm was more favourable than the control arm in terms of the differences from pre- to postintervention phases in the proportions of patients prescribed with OACs (15.1 percent, 95 percent CI, 0–31.5 percent) and with DOACs (20 percent, 0–39.8 percent).

This cluster randomized trial from April 2015 to September 2018 sought to determine whether a simulation-based education addressed to physicians could increase the proportions of elderly patients with AF prescribed with OACs compared with usual practice.

Thirty-two Italian internal medicine and geriatric wards were randomly assigned 1:1 to intervention or control arms. Physicians of wards randomized to intervention received a computer-based e-learning tool with clinical scenarios (Dr Sim), while those of wards randomized to control received no formal educational intervention.

The OAC prescription rate at hospital discharge in the intervention and control arms was the primary outcome.