The Library
Automated software system to promote anticoagulation and reduce stroke risk
Tools
Holt, Tim A., Dalton, Andrew, Marshall, Tom, Fay, Matthew, Qureshi, Nadeem, Kirkpatrick, Susan, Hislop, Jenny, Lasserson, Daniel, Kearley, Karen, Mollison, Jill, Yu, Ly-Mee, Hobbs, F.D. Richard and Fitzmaurice, David (2017) Automated software system to promote anticoagulation and reduce stroke risk. Stroke, 48 (3). pp. 787-790. doi:10.1161/STROKEAHA.116.015468 ISSN 0039-2499.
Research output not available from this repository.
Request-a-Copy directly from author or use local Library Get it For Me service.
Official URL: http://dx.doi.org/10.1161/STROKEAHA.116.015468
Abstract
Background and Purpose: Oral anticoagulants (OAC) substantially reduce risk of stroke in atrial fibrillation, but uptake is suboptimal. Electronic health records enable automated identification of people at risk but not receiving treatment. We investigated the effectiveness of a software tool (AURAS-AF [Automated Risk Assessment for Stroke in Atrial Fibrillation]) designed to identify such individuals during routine care through a cluster-randomized trial.
Methods: Screen reminders appeared each time the electronic health records 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 6 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 randomized. 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% confidence interval −0.72 to 3.13]). Incidence of recorded transient ischemic attack was higher in the intervention practices (median 10.0 versus 2.3 per 1000 patients with atrial fibrillation; P=0.027), but at 12 months, we found a lower incidence of both all cause stroke (P=0.06) and hemorrhage (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 transient ischemic attack (possibly because of improved detection or overdiagnosis) was associated with a reduction (of borderline significance) in stroke and hemorrhage over 12 months.
Item Type: | Journal Article | ||||||
---|---|---|---|---|---|---|---|
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
||||||
Journal or Publication Title: | Stroke | ||||||
Publisher: | Lippincott Williams & Wilkins | ||||||
ISSN: | 0039-2499 | ||||||
Official Date: | 24 January 2017 | ||||||
Dates: |
|
||||||
Volume: | 48 | ||||||
Number: | 3 | ||||||
Page Range: | pp. 787-790 | ||||||
DOI: | 10.1161/STROKEAHA.116.015468 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Restricted or Subscription Access |
Request changes or add full text files to a record
Repository staff actions (login required)
View Item |