Education of healthcare professionals to improve guideline adherence in atrial fibrillation: the STEEER-AF cluster-randomized clinical trial

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. ClinicalTrials.gov registration: NCT04396418 .

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Publication Details

Journal
Nature Medicine
Published
2025-06-13
DOI
https://doi.org/10.1038/s41591-025-03751-2
Citations
6
Primary Topic
Atrial Fibrillation Management and Outcomes
Type
article
Field-Weighted Citation Impact
8.33

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article

Education of healthcare professionals to improve guideline adherence in atrial fibrillation: the STEEER-AF cluster-randomized clinical trial

Dipak Kotecha, Isabelle C. Van Gelder, Yongzhong Sun, Samir Mehta et al.
6 citations
Nature Medicine
Atrial Fibrillation Management and Outcomes
8.33
article

Education of healthcare professionals to improve guideline adherence in atrial fibrillation: the STEEER-AF cluster-randomized clinical trial

Dipak Kotecha, Isabelle C. Van Gelder, Yongzhong Sun, Samir Mehta, Karina V Bunting, Colinda van Deutekom, Eduard Guasch, Serge Bovéda, Kim Rajappan, Tom J. R. De Potter, Philipp Sommer, Chris P Gale, Maciej M. Sterlinski, Lluís Mont, Giuseppe Boriani
article en
6 citations

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. ClinicalTrials.gov registration: NCT04396418 .

Nature MedicineVol. 31(8)
University of Modena and Reggio Emilia (IT), National Health Service (GB), Swansea Bay University Health Board (GB), St Bartholomew's Hospital (GB), University of Leeds (GB), University Hospitals Birmingham NHS Foundation Trust (GB), University Medical Center Groningen (NL), University of Helsinki (FI), Vrije Universiteit Brussel (BE), Université de Bordeaux (FR), Witten/Herdecke University (DE), Medical University of Silesia (PL), University of Groningen (NL), Carleton College (US), University of Milan (IT), Université Paris-Est Créteil (FR), University of Campania "Luigi Vanvitelli" (IT), University of Wrocław (PL), Barts Health NHS Trust (GB), University of Siedlce (PL), Medical University of Warsaw (PL), Queen Elizabeth Hospital Birmingham (GB), Leeds Teaching Hospitals NHS Trust (GB), Santa Maria Nuova Hospital (IT), Norfolk and Norwich University Hospital (GB), Horton General Hospital (GB), Helsinki University Hospital (FI), Heart and Diabetes Center North Rhine-Westphalia (DE), Centre Hospitalier Universitaire de Grenoble (FR), Hospital Universitario La Paz (ES), Combined Military Hospital (PK), James Cook University Hospital (GB), Buckinghamshire Healthcare NHS Trust (GB), Royal Devon and Exeter Hospital (GB), Hospital de Sant Pau (ES), Bellvitge University Hospital (ES), Oxford Health NHS Foundation Trust (GB), Gloucestershire Hospitals NHS Foundation Trust (GB), University Hospital Complex Of Vigo (ES), Hospital Universitari i Politècnic La Fe (ES), Centre Hospitalier Universitaire Henri-Mondor (FR), Pułtusk Academy of Humanities (PL), Université de Poitiers (FR), Medizinische Hochschule Hannover (DE), National Institute for Health and Care Research (GB), Sorbonne Université (FR), Northampton General Hospital NHS Trust (GB), National Institute of Cardiovascular Diseases (SK), Centro de Investigación en Red en Enfermedades Cardiovasculares (ES), United Heart and Vascular Clinic (US), Royal Brompton Hospital (GB), IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT), Assistance Publique – Hôpitaux de Paris (FR), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (ES), Centre Hospitalier Régional et Universitaire de Nancy (FR), Antwerp University Hospital (BE), Hôpital Européen Georges-Pompidou (FR), Centre Hospitalier De Pau (FR), Hospital Universitario Puerta de Hierro Majadahonda (ES), Azienda Ospedaliero-Universitaria di Modena (IT), Homerton University Hospital NHS Foundation Trust (GB), Centar za Promociju Nauke (RS), University Hospital Schleswig-Holstein (DE), Institut d'Investigació Biomèdica de Girona (ES), Hospital Universitario Miguel Servet (ES), Centro de Investigación Biomédica en Red (ES), Paracelsus Medizinische Privatuniversität (DE), CHU Dijon Bourgogne (FR), Federico II University Hospital (IT), München Klinik (DE), Pitié-Salpêtrière Hospital (FR), Asklepios Klinik St. Georg (DE), The Arrhythmia Institute (US), Hôpital Rangueil (FR), Universitätsklinikum Würzburg (DE), Vall d'Hebron Hospital Universitari (ES), Hôpitaux Universitaires Henri-Mondor (FR), Krankenhaus der Elisabethinen (AT), Klinikum Arnsberg (DE), Cancer Research UK Clinical Trials Unit (GB), Praxis für Humangenetik (DE), Institute of Cardiology (PL), Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (ES), 1 Military Clinical Hospital with Outpatient Clinic (PL), Hospital General Universitario de Alicante Doctor Balmis (ES), Clinique Pasteur (FR), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), Wojewódzki Szpital Zespolony (PL), Hôpital d'Instruction des Armées Sainte-Anne (FR), Hospital Universitario Puerta del Mar (ES), Milton Keynes Hospital NHS Foundation Trust (GB), Oxford University Hospitals NHS Trust (GB), Ospedale Sant'Anna (IT), Electrophysiology Research Foundation (US), Segeberger Kliniken (DE), Centre Hospitalier Intercommunal Toulon-La Seyne-sur-Mer (FR), Hospital Universitario Virgen del Rocío (ES), Marienhospital Osnabrück (DE), Hospital Universitari Germans Trias i Pujol (ES), Centre de Recherche Cardio-Thoracique de Bordeaux (FR), Centre Cardiologique du Nord (FR), Centre Hospitalier Universitaire de Rouen (FR), Hospital Universitari de Girona Doctor Josep Trueta (ES), Centre Hospitalier Universitaire de Rennes (FR), Grochowski Hospital (PL), St. Anna Hospital (DE), Hôpital Dupuytren (FR), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), York District Hospital (US), NIHR Birmingham Biomedical Research Centre (GB), Oldham Council (GB), NIHR Leicester Biomedical Research Centre (GB), University of Florence (IT), Imperial College London (GB), Université de Rouen Normandie (FR), Universitat de Barcelona (ES), Charité - Universitätsmedizin Berlin (DE), University of Birmingham (GB), Université Grenoble Alpes (FR), University of Lübeck (DE)
Bristol-Myers Squibb, Pfizer, AstraZeneca, Sanofi, Boston Scientific Corporation, Barts Charity, National Institute for Health and Care Research, British Heart Foundation, MicroPort, Medical Research Council, Biosense Webster, Daiichi Sankyo Europe
Openalex Percentile: Top 2%
Atrial Fibrillation Management and Outcomes
8.33
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