Impact of an Atrial Fibrillation Decision Support Tool on thromboprophylaxis for atrial fibrillation
Impact of an Atrial Fibrillation Decision Support Tool on thromboprophylaxis for atrial fibrillation
复制标题
DOI：
10.1016/j.ahj.2016.02.009
复制
发表时间：
2016-06-01
影响因子：
4.8
通讯作者：
Kues, John
中科院分区：
文献类型：
--
作者：
Eckman, Mark H.;Lip, Gregory Y. H.;Kues, John
背景房颤（AF）患者适当的血栓预防仍然是一个全国性的挑战。方法我们假设以房颤决策支持工具（AFDST）的形式提供决策支持将改善房颤患者的血栓预防。2014年4月至2015年2月，我们在一个综合医疗保健系统中进行了一项分组随机试验，涉及15个初级保健诊所和1493名非瓣膜性房颤成人。干预组的医生接受由AFDST提出的患者层面的治疗建议。我们的主要结局是接受抗血栓治疗的患者比例与AFDST推荐不一致。结果干预组801例患者中有42%出现治疗不一致。医生审阅了240名患者的报告。在这些患者中，63%的血栓预防不一致，1年后下降到59% （P = 0.02）。在非分层分析中，干预组和对照组之间不和谐护理的变化无显著差异。在多元回归模型中，分配到干预组导致不一致性降低的趋势不显著（P = 0.29），作为住院医师的患者（P = 0.02）和较高的ha - bled评分预测不一致性降低（P = 0.03），而女性（P = 0.01）和较高的CHADSVASc评分（P = 0.10）预测不一致性增加。结论：在医生审查了决策支持工具推荐的患者中，不一致治疗在1年内显著减少。然而，在非分层分析中，干预并没有导致不一致抗血栓治疗的显著改善。
Background Appropriate thromboprophylaxis for patients with atrial fibrillation (AF) remains a national challenge.Methods We hypothesized that provision of decision support in the form of an Atrial Fibrillation Decision Support Tool (AFDST) would improve thromboprophylaxis for AF patients. We conducted a cluster randomized trial involving 15 primary care practices and 1,493 adults with nonvalvular AF in an integrated health care system between April 2014 and February 2015. Physicians in the intervention group received patient-level treatment recommendations made by the AFDST. Our primary outcome was the proportion of patients with antithrombotic therapy that was discordant from AFDST recommendation.Results Treatment was discordant in 42% of 801 patients in the intervention group. Physicians reviewed reports for 240 patients. Among these patients, thromboprophylaxis was discordant in 63%, decreasing to 59% 1 year later (P = .02). In nonstratified analyses, changes in discordant care were not significantly different between the intervention group and control groups. In multivariate regression models, assignment to the intervention group resulted in a nonsignificant trend toward decreased discordance (P = .29), and being a patient of a resident physician (P = .02) and a higher HAS-BLED score predicted decreased discordance (P = .03), whereas female gender (P = .01) and a higher CHADSVASc score (P = .10) predicted increased discordance.Conclusions Among patients whose physicians reviewed recommendations of the decision support tool discordant therapy decreased significantly over 1 year. However, in nonstratified analyses, the intervention did not result in significant improvements in discordant antithrombotic therapy.