Preventing SCD Post-MI Via the Use of Virtual Patient Simulation: Success of Online Education

Spyropoulos, Jelena

Background:
Patients with a myocardial infarction (MI) are at high risk for sudden cardiac death (SCD) in the immediate period post-hospital discharge. This study was conducted to determine if an online, virtual patient simulation (VPS)-based continuing medical education (CME) intervention could improve performance of cardiologists in using appropriate strategies to prevent SCD post-hospital discharge.

Methods:
The CME intervention consisted of two cases presented in a VPS platform that allowed learners to order lab tests, diagnoses and treatments in a manner matching the scope and depth of actual practice. Clinical decisions made by the learners using open field entries within an EHR interface were analyzed using an artificial intelligence engine and, after each decision, tailored clinical guidance (CG) was provided based on current evidence and expert recommendation. Learner decisions were collected post-CG and compared with each user’s baseline (pre-CG) data using a 2-tailed paired T-test to determine P values. P values of <.05 were considered significant.

Results:
Significant absolute improvements were observed after clinical guidance (CG): Case 1 (n=574 cardiologists):

Diagnose NYHA Class II HFrEF: 23% improvement (8% pre-CG vs 31% post-CG; P<.001)
Order beta-blocker therapy: 19% improvement (24% pre-CG vs 43% post-CG; P<.001)
Order shared-decision making to determine if the patient is a candidate for a wearable cardio defibrillator (WCD): 9% improvement (24% pre-CG vs 33% post-CG; P<.001)
Order WCD: 10% improvement (23% pre-CG vs 33% post-CG; P<.001)

Case 2 (n=337 cardiologists):

Diagnose NYHA Class III HFrEF: 21% improvement (18% pre-CG vs 39% post-CG; P<.001)
Order WCD: 13% improvement (25% pre-CG vs 38% post-CG; P<.001

Conclusions:
This study demonstrated that VPS-based CME that immerses and engages learners in an authentic and practical learning experience can improve evidence-based practices of cardiologists and suggests that this type of intervention can improve outcomes for patients at risk for SCD.