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. 2024 Oct 8;5(1):205-213.
doi: 10.1016/j.jacasi.2024.08.011. eCollection 2025 Jan.

Impact of Educational Intervention on Anticoagulation Control Using SAMe-TT22R2 Score-Guided Strategy in Atrial Fibrillation

Arintaya Phrommintikul  1 , Surakit Nathisuwan  2 , Wanwarang Wongcharoen  1 , Rungroj Krittayaphong  3 , Siriluck Gunaparn  1 , Antika Wongthanee  1 , Jonathan Mathers  4 , Sue Jowett  4 , Kate Jolly  4 , Deirdre A Lane  5   6   7 , G Neil Thomas  4 , Gregory Y H Lip  6   7 ; TREATS-AF Study Group
Collaborators, Affiliations

Impact of Educational Intervention on Anticoagulation Control Using SAMe-TT22R2 Score-Guided Strategy in Atrial Fibrillation

Arintaya Phrommintikul et al. JACC Asia. .

Abstract

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-TT2R2 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-TT2R2 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-TT2R2 score-guided strategy or usual care. In the SAMe-TT2R2 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-TT2R2 score-guided strategy plus usual care (n = 156) or usual care alone (n = 164). Mean CHA2DS2-VASc score and SAMe-TT2R2 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-TT2R2 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-TT2R2 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-TT2R2 score guided strategy in anticoagulant-naive Thai patients with atrial fibrillation; TCTR20180711003).

Keywords: SAMe-TT2R2 score; anticoagulants; atrial fibrillation; education-behavioral; warfarin.

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Conflict of interest statement

This study is supported by the Newton Fund through the collaboration of the Medical Research Council (MRC; MR/R020892/1), the United Kingdom, and the Thailand Research Fund (TRF; DBG6180009), Thailand. Dr Phrommintikul has received speaker fees from Bayer, Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo outside the submitted work. Dr Wongcharoen has received speaker fees from Bayer, Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo outside the submitted work. Dr Lane has received investigator-initiated educational grants from Bristol Myers Squibb (BMS) and Pfizer; has received speaker fees for Boehringer Ingelheim, Bayer, and BMS/Pfizer; and has been a consultant for BMS/Pfizer and Boehringer Ingelheim, all outside of the submitted work. Prof Lip has received institutional consultancy and speaker fees for BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Consort Flow Diagram Atrial fibrillation patients were randomized to SAMe-TT2 R2 score-guided strategy plus usual care vs usual care alone. Patients assigned to the SAMe-TT2 R2 group who had a SAMe-TT2 R2 score 0 to 2 received usual care, whereas those who had SAMe-TT2 R2 >2 received TREAT intervention plus usual care. FU = follow-up.
Central illustration
Central illustration
Effects of Educational Intervention for Anticoagulation Management in Atrial Fibrillation Patients Adult patients with atrial fibrillation (AF) who were eligible for warfarin were randomized to SAMe-TT2 R2 score-guided strategy vs usual care. Patients assigned to the SAMe-TT2 R2 group who had SAMe-TT2 R2 score 0 to 2 received usual care, whereas those who had SAMe-TT2 R2 >2 received TREAT intervention plus usual care. There was no significant difference in time in therapeutic range (TTR) between the 2 groups at both 6 and 12 months.
See this image and copyright information in PMC

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