Clinical InvestigationImpact of an Atrial Fibrillation Decision Support Tool on thromboprophylaxis for atrial fibrillation
Section snippets
Methods
We used our health system's clinical data store to identify 9,270 patients with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of AF (427.31) or atrial flutter (427.32) who did not have diagnoses of mitral valve disease (394.x), aortic valve disease (395.x), heart valve transplant (V42.2), or heart valve replacement (V42.3) in their active problem list. The data pull to form our inception cohort was performed in February of 2014. Because our
Results
Characteristics of patients and practices in each of the arms of the study are described in Table I. Results are only reported for patients who were part of the inception cohort formed in 2014. The 84 patients who died over the year were censored from these numbers. For the most part, patients in both groups were demographically comparable, and a similar proportion were receiving OAT. There were a slightly higher proportion of faculty members and a lower proportion of residents in the control
Discussion
A randomized controlled trial examining the impact of implementing the AFDST demonstrated no significant improvement in discordant antithrombotic therapy compared with a group of control practices that did not receive the tool. However, discordant therapy decreased significantly over a 1-year period of time for patients whose physicians actually reviewed the reports and recommendations of the decision support tool. This suggests that the AFDST can have a beneficial impact on clinical care if it
Conclusions
A randomized controlled trial examining the impact of implementing an AFDST found that among patients whose physicians actually reviewed the reports and recommendations of the decision support tool, discordant therapy decreased significantly over a 1-year period. However, in nonstratified analyses, the intervention did not result in significant improvements in discordant antithrombotic therapy. These findings suggest the next steps we must take to decrease barriers to the convenient and more
Author contributions
M.H.E., G.Y.H.L., R.E.W., F.L.F., D.K., C.A., A.L., A.C., and J.K. participated in the conception and design of the project; M.S., L.A., N.W., B.S., J.K., P.B., R.I., D.H., and B.M.H. were responsible for acquisition of data; M.H.E., A.L., and L.A. were responsible for data analysis and interpretation; M.H.E. drafted the original article; M.H.E., G.Y.H.L., R.E.W., S.B., M.S., N.W., B.K., M.L.F., D.K., P.B., R.I., D.H., B.M.H., C.A., A.L., L.A., D.S., A.C., and J.K. contributed to critical
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Cited by (39)
Atrial fibrillation: epidemiology, screening and digital health
2024, The Lancet Regional Health - EuropeElectronic health record-embedded decision support to reduce stroke risk in patients with atrial fibrillation – Study protocol
2022, American Heart JournalCitation Excerpt :Net clinical benefit was defined by gain or loss in QALYs between current treatment and treatment recommended by the decision model. In 2016, we conducted a cluster randomized trial of a free-standing web-based version of the AFDST in our University of Cincinnati Health system's 15 primary care practices, including 70 physicians and 1,493 adults with non-valvular AF.26 Physicians in the intervention group received patient-level recommendations made by an AFDST configured as a stand-alone, secure website.
Strategies for improving guideline adherence of anticoagulants for patients with atrial fibrillation in primary healthcare: A systematic review
2021, Thrombosis ResearchCitation Excerpt :Majority of the studies were judged to have low risk of bias (Appendix 2). Of the 33 studies included in this review, 20 [20–39] were before-after studies, 12 [40–51] were cluster randomized studies, and 1 [52] was a randomized controlled trial (Appendix 3). Seventeen studies [20,22–28,30–32,34,37,43,44,49,51] had multifaceted interventions (supplemented one type of intervention with other interventions) while 16 studies [21,29,33,35,36,38–43,46–48,50,52] applied single-faceted interventions.
An audit & feedback intervention for improved anticoagulant use in patients with atrial fibrillation in primary care
2020, International Journal of Cardiology
Funding sources: Support for this study came from the Pfizer Educational Group, Bristol-Myers Squibb/Pfizer Education Consortium, and National Institutes of Health/National Center for Advancing Translational Sciences (Grant 8 UL1 TR000077-05). The funding sources had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
RCT No. NCT02524977.