A recent study by Rockpointe demonstrated the value of CME for atrial fibrillation (AFib) patients and the physicians who treat them, while also confirming the need for additional education for the broader audience of clinicians. The study, Impact of Continuing Medical Education on the Recognition of Silent Atrial Fibrillation and Mitigation of Atrial Fibrillation-related Stroke Risk, involved primary care physicians (PCPs) and other healthcare professionals who treat patients who have stroke-associated risk factors and might also have AFib. The results were presented at the 25th Annual Atrial Fibrillation Symposium poster session on January 23 and 24, 2020 in Washington, DC.
Rockpointe analyzed outcomes from three live activities in conjunction with chapter meetings of the American College of Physicians, three live activities at Medical Education Exchange (MEDX) Regional Conferences, and an online enduring webcourse hosted on Primary Issues. The live activities drew more than 1,300 participants, and nearly 1,200 learners viewed the webcourse. The education’s impact was assessed by comparing pre- and post-activity test scores, which indicated that participants were roughly 50% more likely to deliver evidence-based care for AFib after the activity, potentially improving care during more than 12,000 AFib patient-visits each month.
Before the education, 58% of participants were unfamiliar with at least half of the material presented. Based on clinician responses to knowledge questions, the overall pre-test score was 63%, while the overall post-test score was 94%; P<0.05.
Participant evaluations also suggested the education was highly effective. Of the 1,125 participants who responded to the evaluation, 99% agreed that the activity provided strategies to improve their practices and better prepared them to care for their patients.
Participants became more confident in their ability to identify patients at high risk of stroke using novel approaches and in using CHA2DS2-VASc to diagnose/manage AFib and select oral anticoagulant therapy for newly diagnosed AFib. They also expressed an intention to incorporate this information into their practices.
Pre-test scores also confirmed the need for more education to the broader target audience on the following subjects:
- Identifying patients at high risk for stroke who have not been diagnosed with AFib;
- Using the CHA2DS2-VASc Risk Score; and
- Individualizing oral anticoagulant (OAC) therapy in patients with AFib.
AFib is the most common heart rhythm disorder and increases the risk of stroke; however, approximately one-third of people with AFib are asymptomatic and remain undiagnosed. Therefore, early diagnosis of AFib must be a priority to prevent cardiovascular disease and stroke.
To identify individuals with silent AFib, guidelines recommend screening patients aged ≥65 years using pulse palpation, electrocardiogram (ECG), or hand-held devices. Another approach for early identification of AFib is to conduct routine ECG screening, but such screening is not a good tool to detect sporadic infrequent events that are often silent or asymptomatic. Studies using various ECG monitoring apps have established that prolonged ECG monitoring increases the yield of AFib detection. Unfortunately, many PCPs are unaware of silent-AFib prevalence and few test for it
Once an individual is diagnosed with AFib, guidelines recommend quantitating stroke risk using the CHA2DS2VASc score. However, stroke risk scores are seldom calculated in real-world settings. Clinicians are often unfamiliar with their use or have insufficient time to determine a patient’s risk score and rely on clinical judgment alone. Patients not assessed using the CHA2DS2VASc score are at risk of receiving guideline-discordant care, as evidence-based management depends on scoring results. Many patients who should receive an anticoagulant are untreated, are not given the optimal evidence-based choice of oral anticoagulant (OAC), or do not receive the appropriate dose.
Rockpointe developed the above educational interventions based on these knowledge and competence gaps in order to help PCPs recognize the need to screen for asymptomatic AFib, use the CHA2DS2VASc score to assess stroke risk, and improve their knowledge about OACs to individualize the management of their patients with AFib.
Through effective continuing medical education, Rockpointe strives to improve and advance the quality of patient care. Its educational programs have been at the forefront of new issues in healthcare, including implementing MIPS, combating the nation’s opioid crisis, and utilizing technical advances that improve care. As part of its commitment to quality, Rockpointe works to inform the continuing-education community of significant quality-improvement issues through news and analysis on Policy and Medicine. In addition, its popular Medical Education Exchange (MEDX) CME regional meetings include sessions on the basics of quality improvement and alternative payment models, as well as relevant and scientifically accurate sessions on numerous disease states. All sessions include links back to associated National Quality Priorities to reinforce the bigger picture and the triple aim of: 1) improving health and 2) lowering cost to 3) better the patient experience. At Rockpointe, education equals quality.