Development of a Computerised Antithrombotic Risk Assessment Tool (CARAT) to optimise therapy in older persons with atrial fibrillation.
OBJECTIVE
To develop and evaluate a novel Computerised Antithrombotic Risk Assessment Tool (CARAT) to aid clinicians' decision making regarding the risk-benefit of antithrombotic therapy in older patients.


METHODS
CARAT was developed in an iterative process involving multidisciplinary feedback and computerisation of previously trialled algorithms. Hospital-based clinicians then applied the tool to patient cases, to evaluate its usability.


RESULTS
Overall, 94% of clinicians (n= 27 yielding 216 responses) were satisfied with CARAT's format. Most (72%) clinician responses agreed with CARAT recommendations; over two-thirds agreed with estimates of stroke and bleeding risk. However, geriatricians were 3.5 times more likely to disagree with CARAT recommendations than cardiologists, particularly in cases of high fall risk. Overall, 63% responded that CARAT was at least 'somewhat useful' for clinical practice; 22% indicating it was 'very useful'.


CONCLUSIONS
CARAT has potential as a useful decision-support tool to assist clinicians in decision making regarding appropriate antithrombotic therapy in older patients.
Graduate School of Pharmacy, University of Technology Sydney, Sydney, New South Wales, Australia. beata.bajorek@uts.edu.au
Beata V
BV
Bajorek
Noman
N
Masood
Ines
I
Krass
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D003661:Decision Support Techniques; D004360:Drug Therapy, Computer-Assisted; D005246:Feedback; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007722:Health Knowledge, Attitudes, Practice; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents