A new study led by Professor Dipak Kotecha from the University of Birmingham has shown that a targeted training programme for healthcare professionals can improve part of the care of patients with atrial fibrillation (AF), a common heart rhythm disorder. The STEEER-AF cluster-randomised trial was presented today at the European Society of Cardiology (ESC) Congress 2024 in a hotline session.

The study found that adherence to existing AF treatment guidelines was generally low across Europe. However, a short, structured educational programme for healthcare professionals led to a 51% improvement in guideline adherence for heart rhythm control, although not a significant improvement for stroke prevention. Improved adherence to guidelines means better care and outcomes for patients with AF.

While guidelines aim to support healthcare professionals in applying optimal care, their recommendations are often not implemented in clinical practice, with education of healthcare staff identified as a major barrier. The STEEER-AF trial demonstrates that targeted education for healthcare professionals can improve patient-level guideline adherence where there are substantial gaps in implementation.

Professor Dipak Kotecha

The STEEER-AF trial, the first of its kind conducted by the ESC, involved 1,732 patients from 70 randomised centres in France, Germany, Italy, Poland, Spain and the UK. Healthcare professionals at selected treatment centres were given additional training focused on stroke prevention, rhythm control, and integrated care; while at the remaining centres, healthcare professionals received only their existing educational activities.

At the end of the trial, the research team compared outcomes for the two groups, and examined how well healthcare professionals followed guidelines for prevention of stroke and other blood clots, and to control heart rhythm in patients with atrial fibrillation. The global team also looked at how often the guidelines were followed, how many patients received the right blood thinning medication, and how patients felt about their overall care and quality of life.

While there was no significant change in guideline adherence for stroke prevention, a significant 51% improvement was observed in guideline adherence for rhythm control. Only 1 in 5 patients were compliant with class I and class III guideline recommendations for rhythm control at baseline (the “must do’s” and “must do not’s”).

Professor Kotecha, Chief Investigator of the trial and Professor of Cardiology at the University of Birmingham and the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, said: “The STEEER-AF trial demonstrates that the care of patients with AF is often poorly adherent to guideline recommendations, leading to potentially avoidable strokes, bleeding events and even vascular dementia in the long term. The results of the trial require a total re-think of how guidelines are constructed, disseminated and implemented.”

In parallel to STEEER-AF, Professors Kotecha and Van Gelder (from the University Medical Center Groningen in the Netherlands) co-chaired the new 2024 ESC Guidelines for the management of AF. These new guidelines incorporate numerous approaches to enhance ‘AF-CARE’ – patient pathways designed to make implementing recommendations easier and more consistent. In addition, the ESC has simultaneously launched a patient version of the 2024 AF Guideline, designed to empower patients and encourage a shared-care approach with multidisciplinary healthcare staff.