An International Multicenter clustered randomized controlled trial to imProve treatment with AntiCoagulanTs in patients with atrial fibrillation.

Prior observational studies such as the Rely-AF registry have demonstrated that the proportion of eligible patients with a diagnosis of atrial fibrillation receiving oral anticoagulation is sub-optimal. The registry also demonstrated poor levels of INR control, particularly in South Asian patients. IMPACT study aims to improve the proportion of eligible patients on oral anticoagulants and optimize oral anticoagulation in atrial fibrillation patients. We hypothesize that an educational intervention directed towards the physicians and patients will increase the proportion of eligible patients who are treated with oral anticoagulation and will further increase patient adherence and persistence to oral anticoagulation for 1 year. We propose to evaluate the intervention using a cluster randomized design, with the hospital being the unit of randomization. Physicians in the ’intervention’ clusters will receive the latest guidelines (ACC/AHA and NICE) on the management of atrial fibrillation and attend online webinars and live summits. At the patient level, patients will receive educational material on atrial fibrillation, its treatment and the importance of adhering to therapy. Furthermore, the patients will be followed up by trained non-physician health workers, who will facilitate regular follow-ups and improve communication between physicians and patients. We will recruit 600 patients and work with different  hospitals across India for the IMPACT study. Patients will be followed up for 1 year.