Impact of an Atrial Fibrillation Decision Support Tool on thromboprophylaxis for atrial fibrillation.
BACKGROUND
Appropriate thromboprophylaxis for patients with atrial fibrillation (AF) remains a national challenge.


METHODS
We hypothesized that provision of decision support in the form of an Atrial Fibrillation Decision Support Tool (AFDST) would improve thromboprophylaxis for AF patients. We conducted a cluster randomized trial involving 15 primary care practices and 1,493 adults with nonvalvular AF in an integrated health care system between April 2014 and February 2015. Physicians in the intervention group received patient-level treatment recommendations made by the AFDST. Our primary outcome was the proportion of patients with antithrombotic therapy that was discordant from AFDST recommendation.


RESULTS
Treatment was discordant in 42% of 801 patients in the intervention group. Physicians reviewed reports for 240 patients. Among these patients, thromboprophylaxis was discordant in 63%, decreasing to 59% 1 year later (P = .02). In nonstratified analyses, changes in discordant care were not significantly different between the intervention group and control groups. In multivariate regression models, assignment to the intervention group resulted in a nonsignificant trend toward decreased discordance (P = .29), and being a patient of a resident physician (P = .02) and a higher HAS-BLED score predicted decreased discordance (P = .03), whereas female gender (P = .01) and a higher CHADSVASc score (P = .10) predicted increased discordance.


CONCLUSIONS
Among patients whose physicians reviewed recommendations of the decision support tool discordant therapy decreased significantly over 1 year. However, in nonstratified analyses, the intervention did not result in significant improvements in discordant antithrombotic therapy.
Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati (UC), Cincinnati, OH; Center for Health Informatics, UC, Cincinnati, OH. Electronic address: mark.eckman@uc.edu.
Mark H
MH
Eckman
University of Birmingham Centre for Cardiovascular Sciences, Birmingham, United Kingdom.
Gregory Y H
GY
Lip
Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati (UC), Cincinnati, OH.
Ruth E
RE
Wise
Department of Family and Community Medicine, UC, Cincinnati, OH.
Barbara
B
Speer
UC Health, Cincinnati, OH.
Megan
M
Sullivan
Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati (UC), Cincinnati, OH.
Nita
N
Walker
Department of Neurology, UC, Cincinnati, OH.
Brett
B
Kissela
Department of Neurology, UC, Cincinnati, OH.
Matthew L
ML
Flaherty
Department of Neurology, UC, Cincinnati, OH.
Dawn
D
Kleindorfer
Center for Health Informatics, UC, Cincinnati, OH.
Peter
P
Baker
Center for Health Informatics, UC, Cincinnati, OH.
Robert
R
Ireton
Center for Health Informatics, UC, Cincinnati, OH.
Dave
D
Hoskins
Center for Health Informatics, UC, Cincinnati, OH.
Brett M
BM
Harnett
Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati (UC), Cincinnati, OH; Center for Health Informatics, UC, Cincinnati, OH.
Carlos
C
Aguilar
Department of Family and Community Medicine, UC, Cincinnati, OH.
Anthony C
AC
Leonard
Department of English, UC, Cincinnati, OH.
Lora
L
Arduser
Division of Cardiology, UC, Cincinnati, OH.
Dylan
D
Steen
Division of Cardiology, UC, Cincinnati, OH.
Alexandru
A
Costea
Department of Family and Community Medicine, UC, Cincinnati, OH.
John
J
Kues
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D018890:Chemoprevention / Q000379:methods / Q000706:statistics & numerical data; D003660:Decision Support Systems, Management / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D018570:Risk Assessment / Q000379:methods; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors