Structured educational program for healthcare professionals improves outcomes of atrial fibrillation management: A Polish subgroup analysis of the European Society of Cardiology STEEER-AF cluster-randomized trial

BACKGROUND: The STEEER-AF trial evaluated the effect of a structured educational program on adherence to European Society of Cardiology guidelines for atrial fibrillation. AIMS: We aimed to report the prespecified subgroup analysis of centers in Poland to evaluate regional guideline adherence and the impact of the educational intervention. METHODS: Twelve Polish centers recruiting 300 patients with atrial fibrillation were randomized 1:1 to an educational intervention for healthcare professionals or standard practice. Co-primary outcomes were patient-level adherence to class I and III European Society of Cardiology recommendations for stroke prevention and rhythm control at 6-9 months. RESULTS: Complete case analysis included 262 patients. Baseline oral anticoagulant prescription was 96.3%. At follow-up, adherence to stroke prevention guidelines was 76.6% in the intervention group and 70.9% in the control group (adjusted risk ratio, 1.12; 95% confidence interval, 0.99-1.27). For rhythm control, guideline adherence reached 53.1% in the intervention group compared with 26.9% in the control group (adjusted risk ratio 1.75; 95% confidence interval, 1.16-2.64). Educational engagement was robust, with learners spending a median of 11.5 hours on the platform. CONCLUSIONS: Following structured professional education, absolute adherence to rhythm control recommendations was substantially higher in the Polish cohort. A near-optimal baseline oral anticoagulant prescription rate limited the capacity for measurable improvement in stroke prevention. These findings are hypothesis-generating and highlight the need for targeted education aligned with local healthcare infrastructure.