For Providers

The goal of the IMPACT-AF initiative is to improve the use of oral anticoagulant medications for stroke prevention in patients with atrial fibrillation (AF). Our objective is to increase awareness and education among patients and providers.

This FDA-sponsored initiative is being conducted by multiple health plans in the U.S. in collaboration with researchers at Harvard and Duke.

Educational materials were sent to health plan participants who appear to have atrial fibrillation, have high stroke risk (CHA2DS2-VASc score ≥ 2), and who have not filled an oral anticoagulant prescription in the past year.

Facts about Atrial Fibrillation

  • Patients with AFib have a five times higher stroke risk relative to patients without AFib.
    (Circulation 2011;123(10):e269–367)
  • More than two-thirds of strokes caused by AFib are preventable with anticoagulation.
    (Annals of internal medicine 146.12 (2007): 857–867)
  • 50% of patients with AFib and high stroke risk have not filled an anticoagulant prescription.
    (Circulation 2014; 129 (15),
    1568–1576)

Common Misperceptions about Stroke Prevention

Misperception: Aspirin is good enough
  • Aspirin reduces stroke by < 20%, if at all, compared with 70% reduction with anticoagulation; therefore, aspirin is not sufficiently effective for stroke prevention.
    (European Heart Journal 2015; 36: 653-656)
Misperception: Patients with AF are at greater risk of bleeding than stroke
  • 30% of elderly patients fall in a year, but a patient would need to fall nearly every day before the risk of intracranial bleeding outweighs the benefits of anticoagulants.
    (Arch Intern Med 1999;159:677-685)
  • The risk of recurrent GI bleeding averages 1.2% per year but would have to exceed 10% before the risk of GI bleeding outweighs the benefit of anticoagulants.
    (Arch Intern Med 2002;162:541-550)

There are appropriate reasons for patients to not take an anticoagulant, including pregnancy and history of intracranial hemorrhage.

What should you do?

Please review this website and the materials mailed to you.

Discuss anticoagulation and stroke risk with your patient(s) at their next visit.

You may call 866-757-0531 or email IMPACT-AFib@duke.edu for more information about IMPACT-AFib.