title: Optimizing Stroke Prevention in Patients With Atrial Fibrillation: A Cluster-Randomized Controlled Trial of a Computerized Antithrombotic Risk Assessment Tool in Australian General Practice, 2012-2013.
abstract: Clinicians have expressed a need for tools to assist in selecting treatments for stroke prevention in patients with atrial fibrillation. The objective of this study was to evaluate the impact of a computerized antithrombotic risk assessment tool (CARAT) on general practitioners' prescribing of antithrombotics for patients with atrial fibrillation.
  
  
  
  A prospective, cluster-randomized controlled trial was conducted in 4 regions (in rural and urban settings) of general practice in New South Wales, Australia (January 2012-June 2013). General practitioner practices were assigned to an intervention arm (CARAT) or control arm (usual care). Antithrombotic therapy prescribing was assessed before and after application of CARAT.
  
  
  
  Overall, the antithrombotic therapies for 393 patients were reviewed by 48 general practitioners; we found no significant baseline differences in use of antithrombotics between the control arm and intervention arm. Compared with control patients, intervention patients (n = 206) were 3.1 times more likely to be recommended warfarin therapy (over any other treatment option; P < .001) and 2.8 times more likely to be recommended any anticoagulant (in preference to antiplatelet; P = .02). General practitioners agreed with most (75.2%) CARAT recommendations; CARAT recommended that 75 (36.4%) patients change therapy. After application of CARAT, the proportion of patients receiving any antithrombotic therapy was unchanged from baseline (99.0%); however, anticoagulant use increased slightly (from 89.3% to 92.2%), and antiplatelet use decreased (from 9.7% to 6.8%).
  
  
  
  Tools such as CARAT can assist clinicians in selecting antithrombotic therapies, particularly in upgrading patients from antiplatelets to anticoagulants. However, the introduction of novel oral anticoagulants has complicated the decision-making process, and tools must evolve to weigh the risks and benefits of these new therapy options.
authors.affiliation: School of Pharmacy, University of Technology Sydney, UTS CB07.04.51, PO Box 123, Broadway NSW 2007, Australia. Email: Beata.Bajorek@uts.edu.au. Dr Bajorek is also affiliated with Royal North Shore Hospital, St Leonards, New South Wales, Australia.
authors.forename: Beata V
authors.initials: BV
authors.lastname: Bajorek
authors.affiliation: University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Parker J
authors.initials: PJ
authors.lastname: Magin
authors.affiliation: Royal North Shore Hospital, St Leonards, New South Wales, Australia.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
authors.affiliation: University of Sydney, New South Wales, Australia.
authors.forename: Ines
authors.initials: I
authors.lastname: Krass
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D005260:Female; D058006:General Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009517:New South Wales; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin