Impact of a hybrid decision support system to improve the adherence to implantable cardioverter defibrillator therapy guidelines for primary prevention of sudden cardiac death
| Autor: | Gustavo Daquarti, Mariano Benzadon, Diego Belardi, Fernando Scazzuso, Leonardo Seoane, Nicolas Vecchio |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Decision support system medicine.medical_specialty medicine.medical_treatment Health Informatics 030204 cardiovascular system & hematology Sudden cardiac death Ventricular Dysfunction Left 03 medical and health sciences 0302 clinical medicine Risk Factors Primary prevention medicine Humans In patient 030212 general & internal medicine Retrospective Studies Ejection fraction business.industry Middle Aged Decision Support Systems Clinical Implantable cardioverter-defibrillator medicine.disease Defibrillators Implantable Icd implantation Primary Prevention Death Sudden Cardiac Treatment Outcome Practice Guidelines as Topic Emergency medicine Female Observational study business |
| Zdroj: | International Journal of Medical Informatics. 114:76-80 |
| ISSN: | 1386-5056 |
| DOI: | 10.1016/j.ijmedinf.2018.03.016 |
| Popis: | Despite the well-documented benefit of implantable cardioverter defibrillator (ICD) in patients with severe left ventricular dysfunction, there is a large number of patients who had not been offered this therapy. The aim of this study is to evaluate the utility of a hybrid decision support system (hCDSS) to improve the adherence to indicate ICD therapy in our institution.We conducted a retrospective, observational and single-center study. An hCDSS focused on patients with severe deterioration of the left ventricular function was implemented, creating a mandatory field containing the value of left ejection fraction and three options to choose:35%, ≤ 35% or unknown. When the option ≤ 35% is checked, an email is automatically sent to the electrophysiology section where the staff can contact the treating physician to discuss the indication of ICD therapy. We measured the number of ICDs implanted before the alert (month 1-21), immediate post and late post alert (month 22-27 and 28-48 months respectively) RESULTS: The rate of ICD implantation increased from 1.76% per month in the pre-intervention period to 4.48% after the intervention (p 0.001). This increase in the rate of ICD implantation remained stable between the immediate and late post-intervention period (4.6 vs. 4.4; p = .8) CONCLUSION: The implementation of a hybrid decision support system was associated with improved adherence to clinical guidelines for prevention of sudden cardiac death, as evidenced by a rapid and sustained increase in the number of ICD implants in patients with severe left ventricular dysfunction. |
| Databáze: | OpenAIRE |
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