Integrating Real-Time Clinical Information to Provide Estimates of Net Clinical Benefit of Antithrombotic Therapy for Patients With Atrial Fibrillation
Integrating Real-Time Clinical Information to Provide Estimates of Net Clinical Benefit of Antithrombotic Therapy for Patients With Atrial Fibrillation
复制标题
DOI：
10.1161/circoutcomes.114.001163
复制
发表时间：
2014-09-01
影响因子：
6.9
通讯作者：
Costea, Alexandru
中科院分区：
文献类型：
--
作者：
Eckman, Mark H.;Wise, Ruth E.;Costea, Alexandru
背景-房颤患者抗凝治疗的指南是基于CHADS（2）或CHA（2）DS（2）VASc评分计算的卒中风险，没有以明确的定量方式整合出血风险。我们的目标是量化的净临床效益改善决策抗血栓therapy.Methods和结果，这项研究是一项回顾性队列研究的1876名成年人与非瓣膜性房颤或扑在初级保健设置的综合医疗保健提供系统之间2012年12月和2014年1月。通过决策分析模型计算报告为质量调整生命年的质量调整预期寿命预测，该模型整合了卒中和出血的患者特异性风险因素，并检查了无抗血栓治疗、阿司匹林或口服华法林抗凝治疗的策略。净临床获益定义为当前治疗与房颤决策支持工具推荐治疗之间的质量调整预期寿命的增加或减少。在931例患者中，当前治疗与房颤决策支持工具推荐的治疗不一致。832例患者的质量调整预期寿命（定义为>= 0.1质量调整寿命年）有临床显著增加。检查了亚组。例如，建议对188名目前未接受抗血栓治疗的患者进行口服抗凝治疗。对于整个队列，共736质量调整的生命年可以获得治疗改变建议的房颤决策支持Tool.Conclusions-Use的决策支持工具，整合患者特定的中风和出血的风险可能会导致显着收益的质量调整的预期寿命为初级保健人群的房颤患者。
Background-Guidelines for anticoagulant therapy in patients with atrial fibrillation are based on stroke risk as calculated by either the CHADS(2) or the CHA(2)DS(2)VASc scores and do not integrate bleeding risk in an explicit, quantitative manner. Our objective was to quantify the net clinical benefit resulting from improved decision making about antithrombotic therapy.Methods and Results-This study is a retrospective cohort study of 1876 adults with nonvalvular atrial fibrillation or flutter seen in primary care settings of an integrated healthcare delivery system between December 2012 and January 2014. Projections for quality-adjusted life expectancy reported as quality-adjusted life-years were calculated by a decision analytic model that integrates patient-specific risk factors for stroke and hemorrhage and examines strategies of no antithrombotic therapy, aspirin, or oral anticoagulation with warfarin. Net clinical benefit was defined by the gain or loss in quality-adjusted life expectancy between current treatment and treatment recommended by an Atrial Fibrillation Decision Support Tool. Current treatment was discordant from treatment recommended by the Atrial Fibrillation Decision Support Tool in 931 patients. A clinically significant gain in quality-adjusted life expectancy (defined as >= 0.1 quality-adjusted life-years) was projected in 832 patients. Subgroups were examined. For example, oral anticoagulant therapy was recommended for 188 who currently were receiving no antithrombotic therapy. For the entire cohort, a total of 736 quality-adjusted life-years could be gained were treatment changed to that recommended by the Atrial Fibrillation Decision Support Tool.Conclusions-Use of a decision support tool that integrates patient-specific stroke and bleeding risk could result in significant gains in quality-adjusted life expectancy for a primary care population of patients with atrial fibrillation.