Electronic alerts to initiate anticoagulation dialogue in patients with atrial fibrillation.

Autor: Gutierrez JA; Cardiology Section, Durham VA Medical Center, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC. Electronic address: antonio.gutierrez@duke.edu., Christian RT; TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Aday AW; Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN., Gu L; Cardiology Section, Durham VA Medical Center, Durham, NC., Schulteis RD; Cardiology Section, Durham VA Medical Center, Durham, NC., Shihai L; Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT., Petrini M; Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT., Sun AY; Cardiology Section, Durham VA Medical Center, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC., Swaminathan RV; Cardiology Section, Durham VA Medical Center, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC., Katzenberger DR; Cardiology Section, Durham VA Medical Center, Durham, NC., Banerjee S; Cardiology Section, Veterans Affairs North Texas Health Care System, Dallas, TX; Division of Cardiology, University of Texas Southwestern Medical Center, Dallas TX., Rao SV; Cardiology Section, Durham VA Medical Center, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC.
Jazyk: angličtina
Zdroj: American heart journal [Am Heart J] 2022 Mar; Vol. 245, pp. 29-40. Date of Electronic Publication: 2021 Nov 19.
DOI: 10.1016/j.ahj.2021.11.008
Abstrakt: Importance: The benefit of an electronic support system for the prescription and adherence to oral anticoagulation therapy among patients with atrial fibrillation (AF) and atrial flutter at heightened risk for of stroke and systemic thromboembolism is unclear.
Objective: To evaluate the effect of a combined alert intervention and shared decision-making tool to improve prescription rates of oral anticoagulation therapy and adherence.
Design, Setting, and Participants: A prospective single arm study of 939 consecutive patients treated at a large tertiary healthcare system.
Exposures: An electronic support system comprising 1) an electronic alert to identify patients with AF or atrial flutter, a CHA 2 DS 2 -VASc score ≥ 2, and not on oral anticoagulation and 2) electronic shared decision-making tool to promote discussions between providers and patients regarding therapy.
Main Outcomes and Measures: The primary endpoint was prescription rate of anticoagulation therapy. The secondary endpoint was adherence to anticoagulation therapy defined as medication possession ratio ≥ 80% during the 12 months of follow-up.
Results: Between June 13, 2018 and August 31, 2018, the automated intervention identified and triggered a unique alert for 939 consecutive patients with AF or atrial flutter, a CHA 2 DS 2 -VASc score ≥2 who were not on oral anticoagulation. The median CHA 2 DS 2 -VASc score among all patients identified by the alert was 2 and the median untreated duration prior to the alert was 495 days (interquartile range 123 - 1,831 days). Of the patients identified by the alert, 345 (36.7%) initiated anticoagulation therapy and 594 (63.3%) did not: 68.7% were treated with a non-Vitamin K antagonist oral anticoagulant (NOAC), 22.0% with warfarin, and 9.3 % combination of NOAC and warfarin. Compared with historical anticoagulation rates, the electronic alert was associated with a 23.6% increase in anticoagulation prescriptions. The overall 1-year rate of adherence to anticoagulant therapy was 75.4% (260/345).
Conclusion and Relevance: An electronic automated alert can successfully identify patients with AF and atrial flutter at high risk for stroke, increase oral anticoagulation prescription, and support high rates of adherence.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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