Impact of Educational Intervention on Anticoagulation Control Using SAMe-TT2R Score-Guided Strategy in Atrial Fibrillation.

Background: An educational-behavioral intervention has been shown to improve anticoagulation control with warfarin in atrial fibrillation (AF) patients, but widespread application may not be practical. The SAMe-TTR score was formulated to identify the likelihood of achieving optimal time in therapeutic range (TTR).

Objectives: The authors conducted a randomized controlled trial to evaluate the impact of a SAMe-TTR score-guided strategy for an educational-behavioral intervention, compared with usual care on patient's anticoagulation control.

Methods: Anticoagulant-naive adult AF patients were randomized to a SAMe-TTR score-guided strategy or usual care. In the SAMe-TTR score-guided strategy group, scores 0 to 2 received usual care, >2 received educational-behavioral intervention plus usual care. All received warfarin targeting international normalized ratio 2.0 to 3.0. Primary outcome was TTR at 12 months. Secondary outcomes included TTR at 6 months, thromboembolic and bleeding events, major adverse cardiovascular events at 12 months, and change in AF knowledge at 6 and 12 months.

Results: A total of 320 patients (mean age 69.5 years; 48.8% female) were randomized to a SAMe-TTR score-guided strategy plus usual care (n = 156) or usual care alone (n = 164). Mean CHADS-VASc score and SAMe-TTR score were 3.1 ± 1.4 and 3.3 ± 0.9, respectively. At 12 months, mean TTR was not significantly different between groups (41.0 [95% CI: 36.7-45.2] in the SAMe-TTR score-guided strategy vs 40.2 [95% CI: 35.9-44.4] with usual care, and the difference between the 2 groups was 0.7 [95% CI: -5.2 to 6.6]). There were no significant differences in secondary outcomes.

Conclusions: SAMe-TTR score-guided strategy for an educational-behavioral intervention, compared with usual care did not significantly improve outcomes over 12 months. (A prospective randomised trial examining the impact of an intensive educational intervention versus usual care on anticoagulation therapy control based on SAMe-TTR score guided strategy in anticoagulant-naive Thai patients with atrial fibrillation; TCTR20180711003).