Abstract
Background and Purpose
Oral anticoagulants (OAC) substantially reduce risk of stroke in atrial fibrillation (AF), but uptake is suboptimal. Electronic health records (EHRs) enable automated identification of people at risk but not receiving treatment. We investigated the effectiveness of a software tool (AURAS-AF) designed to identify such individuals during routine care, through a cluster-randomised trial.
Methods
Screen reminders appeared each time the EHR of an eligible patient was accessed until a decision had been taken over OAC treatment. Where OAC was not started, clinicians were prompted to indicate a reason. Control practices continued usual care. The primary outcome was the proportion of eligible individuals receiving OAC at six months. Secondary outcomes included rates of cardiovascular events and reports of adverse effects of the software on clinical decision making.
Results
Forty-seven practices were randomised. The mean proportion prescribed OAC at 6 months was 66.3% (SD=9.3) in the intervention arm and 63.9% (9.5) in the control arm, adjusted difference: 1.21% (95% CI -0.72, 3.13). Incidence of recorded transient ischaemic attack (TIA) was higher in the intervention practices (median 10.0 versus 2.3 per 1000 patients with AF, P=0.027), but at twelve months we found a lower incidence of both all cause stroke (p=0.06) and haemorrhage (p=0.054). No adverse effects of the software were reported.
Conclusions
No significant change in OAC prescribing occurred. A greater rate of diagnosis of TIA (possibly due to improved detection or over-diagnosis) was associated with a reduction (of borderline significance) in stroke and haemorrhage over 12 months.
Clinical trial registration
ISRCTN55722437.
Oral anticoagulants (OAC) substantially reduce risk of stroke in atrial fibrillation (AF), but uptake is suboptimal. Electronic health records (EHRs) enable automated identification of people at risk but not receiving treatment. We investigated the effectiveness of a software tool (AURAS-AF) designed to identify such individuals during routine care, through a cluster-randomised trial.
Methods
Screen reminders appeared each time the EHR of an eligible patient was accessed until a decision had been taken over OAC treatment. Where OAC was not started, clinicians were prompted to indicate a reason. Control practices continued usual care. The primary outcome was the proportion of eligible individuals receiving OAC at six months. Secondary outcomes included rates of cardiovascular events and reports of adverse effects of the software on clinical decision making.
Results
Forty-seven practices were randomised. The mean proportion prescribed OAC at 6 months was 66.3% (SD=9.3) in the intervention arm and 63.9% (9.5) in the control arm, adjusted difference: 1.21% (95% CI -0.72, 3.13). Incidence of recorded transient ischaemic attack (TIA) was higher in the intervention practices (median 10.0 versus 2.3 per 1000 patients with AF, P=0.027), but at twelve months we found a lower incidence of both all cause stroke (p=0.06) and haemorrhage (p=0.054). No adverse effects of the software were reported.
Conclusions
No significant change in OAC prescribing occurred. A greater rate of diagnosis of TIA (possibly due to improved detection or over-diagnosis) was associated with a reduction (of borderline significance) in stroke and haemorrhage over 12 months.
Clinical trial registration
ISRCTN55722437.
| Original language | English |
|---|---|
| Pages (from-to) | 787-790 |
| Journal | Stroke |
| Volume | 48 |
| Issue number | 3 |
| Early online date | 24 Jan 2017 |
| DOIs | |
| Publication status | Published - 1 Mar 2017 |
Keywords
- Atrial Fibrillation
- Primary Prevention
- Health Services