Impact of an Atrial Fibrillation Decision Support Tool (AFDST) on Thromboprophylaxis for Atrial Fibrillation
| Status: | Completed |
|---|---|
| Conditions: | Atrial Fibrillation, Atrial Fibrillation |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 10/27/2018 |
| Start Date: | December 2012 |
| End Date: | March 2016 |
Impact of a Quality Improvement And Education Initiative on 'Appropriate' Use of Anticoagulant Therapy in Patients With Atrial Fibrillation
Study objective was to improve decision-making and thromboprophylaxis for patients with
Atrial Fibrillation (AF) by developing and implementing a computerized decision support tool
for individual patient-level decision-making about oral anticoagulant therapy. To accomplish
these goals, the investigators studied the incremental impact of adding a quality-improvement
(QI) intervention to an educational package (for practice staff and clinicians) using a
computerized aid, the Atrial Fibrillation Decision Support Tool (AFDST) for individual
patient-level decision-making about oral anticoagulant therapy in patients with non-valvular
AF. The decision support tool incorporates individual patients' risk factor profiles for
ischemic stroke and bleeding and provides a recommendation for treatment based upon the
projected quality-adjusted life expectancy gained or lost with the addition of either oral
anticoagulant therapy or aspirin compared with no thromboprophylaxis.
Atrial Fibrillation (AF) by developing and implementing a computerized decision support tool
for individual patient-level decision-making about oral anticoagulant therapy. To accomplish
these goals, the investigators studied the incremental impact of adding a quality-improvement
(QI) intervention to an educational package (for practice staff and clinicians) using a
computerized aid, the Atrial Fibrillation Decision Support Tool (AFDST) for individual
patient-level decision-making about oral anticoagulant therapy in patients with non-valvular
AF. The decision support tool incorporates individual patients' risk factor profiles for
ischemic stroke and bleeding and provides a recommendation for treatment based upon the
projected quality-adjusted life expectancy gained or lost with the addition of either oral
anticoagulant therapy or aspirin compared with no thromboprophylaxis.
Setting - Cluster randomized trial. Setting - Primary care practices of an integrated
healthcare system. Participants - 1,493 adults with non-valvular AF seen between April 2014
and March 2015.
Intervention - Treatment recommendations were made by an Atrial Fibrillation Decision Support
Tool (AFDST) based on projections for quality-adjusted life expectancy calculated by a
decision analytic model that integrates patient-specific risk factors for stroke and
hemorrhage.
healthcare system. Participants - 1,493 adults with non-valvular AF seen between April 2014
and March 2015.
Intervention - Treatment recommendations were made by an Atrial Fibrillation Decision Support
Tool (AFDST) based on projections for quality-adjusted life expectancy calculated by a
decision analytic model that integrates patient-specific risk factors for stroke and
hemorrhage.
Inclusion Criteria:
- Study subjects were physicians in our primary care network.
- Patients included in the study were identified through our health system's clinical
data store with an International Classification of Diseases, Ninth Revision, Clinical
Modification (ICD-9-CM), diagnosis of atrial fibrillation (427.31) or atrial flutter
(427.32)
Exclusion Criteria:
Diagnoses of mitral valve disease (394.x), aortic valve disease (395.x), heart valve
transplant (V42.2) or heart valve replacement (V42.3).
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