SPC365

Improving adherence to anticoagulation: a nudge strategy-based intervention on patients with atrial fibrillation or atrial flutter scheduled for electrical cardioversion

Session: Sessão de Posters 03 - Arritmias cardíacas e dispositivos percutâneos no risco cardioembólico
Speaker: Ana Isabel Pinho

Congress: CPC 2024
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.6 Device Therapy - Other
Session Type: Cartazes
FP Number: ---
Authors: Ana Isabel Pinho; Luís Daniel Santos; Cátia Oliveira; João Calvão; Bruno Bragança; Lucy Calvo; Ricardo Alves Pinto; Marta Madeira; Gonçalo Pestana; Luís Adão; Rui André Rodrigues; Ana Lebreiro

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Background: Atrial fibrillation (AF) and atrial flutter (AFL) are important causes of morbidity and are associated with an increased risk of stroke. This risk is particularly high immediately after reversion to sinus rhythm, due to atrial stunning, and can be substantially reduced&nbsp;if preceded by &ge;3 weeks of therapeutic anticoagulation before electrical cardioversion (ECV). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Suboptimal medication adherence is frequent and is associated with increased morbidity, rescheduling of procedures and economic burden. Exploring helpful strategies to overcome this problem is crucial and the use of nudges has shown promising results in promoting adherence to health interventions in other areas.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="color:black">Aim: To investigate the impact of nudging (defined as subtly directing individuals toward positive behavioral choices) on adherence to anticoagulation before elective ECV. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="color:black">Design: Prospective interventional study that included outpatients with AF or AFL scheduled for an elective ECV between May and November 2023, in a Portuguese hospital.</span></span> </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Intervention: Patients (pts) were randomly assigned to receive a short letter (the nudge), via mail, providing education about anticoagulation and potential risks of nonadherence (intervention group) or to usual care (oral information given at the time of appointment - control group). On the day of ECV, pts were asked about optimal adherence to anticoagulation, defined as no missed anticoagulant tablets in the previous 3 weeks, by two different health professionals. A questionnaire was also applied. For pts who failed one or more pills,&nbsp;ECV was postponed and&nbsp;education on anticoagulation was provided.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Results: A total of 65 pts were enrolled (mean age 63&plusmn;11, 33% female, mean CHA<sub>2</sub>DS<sub>2</sub>-VASc score 2.5&plusmn;1.7): 33 in the intervention group and 32 in the control group. There were no significant differences in baseline characteristics between the groups (table 1).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Anticoagulation optimal adherence was higher in the intervention group than in the control group (97% vs 78%, p=0.03). One patient in the intervention arm and 7 pts in the control arm were discharged without undergoing ECV due to suboptimal&nbsp;compliance. Compared with usual care, the number of postponed elective ECV was lower in the group receiving the informative letter, highlighting potential benefits of this nudge strategy (3% vs 22%; OR 0.11 [95% CI 0.01-0.97], p=0.03).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusions: The implementation of a nudge strategy, in the form of a simple informative letter, significantly improved compliance in pts with AF or AFL scheduled for elective ECV. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Given that low awareness about the importance of anticoagulation is a main reason for suboptimal adherence, efforts to inform and alert pts in a straightforward, inexpensive, and accessible way can improve anticoagulation adherence and mitigate the potential harmful consequences of poor compliance, including the costs associated with postponing procedures such as ECV.</span></span></span></p>