Simulation-based education for physicians to increase oral anticoagulants in hospitalized elderly patients with atrial fibrillation

Abstract Purpose To determine whether a simulation-based education addressed to physicians was able to increase the proportion of hospitalized elderly with atrial fibrillation prescribed with oral anticoagulants (OACs), compared with the usual practice. Methods We conducted a cluster randomized trial (April 1, 2015, to September 20, 2018) on 32 Italian internal medicine and geriatric wards 1:1 randomized to intervention or control arms. The physicians of wards randomized to intervention received a computer-based e-learning tool with clinical scenarios (Dr Sim ® ) and those of wards randomized to control received no formal educational intervention. The primary outcome was the OAC prescription rate at hospital discharge in the intervention and control arms. Results Of 452 patients scrutinized, 247 were included in the analysis. Of them, 186 (75.3%) were prescribed with OACs at hospital discharge. No difference was found between the intervention and control arms in the post-intervention phase (OR 1.46 95%CI 0.81–2.64). The differences from the pre- to the post-intervention phases in the proportions of patients prescribed with OACs (15.1%, 95%CI=0% - 31.5%) and with direct oral anticoagulants -DOACs (20%, 95%CI=0% - 39.8%) increased more in the intervention than in the control arm . Conclusions This simulation-based course did not succeed to increase the rate of elderly patients prescribed with OACs at hospital discharge compared to the usual practice. Notwithstanding, over time there was a greater increase in the intervention than in the control arm in the proportion of patients prescribed with OACs and DOACs . Trial Registration. ClinicalTrials.gov identifier: NCT03188211