Electronic alerts to initiate anticoagulation dialogue in patients with atrial fibrillation.
Electronic alerts to initiate anticoagulation dialogue in patients with atrial fibrillation.
复制标题
电子警报可启动心房颤动患者的抗凝对话。
DOI：
10.1016/j.ahj.2021.11.008
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发表时间：
2022
影响因子：
4.8
通讯作者：
Rao,SunilV
中科院分区：
文献类型：
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作者：
Gutierrez,JAntonio;Christian,RuffT;Aday,AaronW;Gu,Lin;Schulteis,RyanD;Shihai,Lu;Petrini,Michaela;Sun,AlbertY;Swaminathan,RajeshV;Katzenberger,DanielR;Banerjee,Subhash;Rao,SunilV
ImportanceThe benefit of a electronic support system for the prescription and adherence to oral antibiotics therapy among patients with atrial fibrillation（AF）and atrial flutter at higher risk for the stroke and systemic thromboembolis.ObjectiveTo.ObjectiveTo. Evaluate the effect of a combined alert intervention and shared decision-making tool to improve prescription rate of oral antibiotics therapy and adherence.一项对在大型三级医疗保健系统接受治疗的939名连续患者的前瞻性单臂研究。一种电子支持系统，包括1）电子警报，用于识别患有AF或心房扑动的患者，CHA 2DS 2-VASc评分≥ 2，而不是口服抗凝剂和2）电子共享决策工具，以促进供应商和患者之间关于治疗的讨论。主要结局和测量主要终点是抗凝治疗的处方率。次要终点是在12个月的随访期间坚持抗凝治疗定义为药物拥有率≥ 80%.ResultsBetween 2018年6月13日和2018年8月31日，自动干预识别并触发了939例连续AF或房扑患者的独特警报，CHA 2DS 2-VASc评分≥2，未口服抗凝剂。警报确定的所有患者的中位CHA 2DS 2-VASc评分为2，警报前的中位未治疗持续时间为495天（四分位数范围123 - 1，831天）。在警报确定的患者中，345例（36.7%）开始抗凝治疗，594例（63.3%）未开始抗凝治疗：68.7%接受非维生素K拮抗剂口服抗凝剂（NOAC）治疗，22.0%接受华法林治疗，9.3%接受NOAC和华法林联合治疗。与历史抗凝率相比，电子警报与抗凝处方增加23.6%相关。1年抗凝治疗依从率为75.4%（260/345）。结论与意义电子自动警报可以成功识别卒中高危房颤和房扑患者，增加口服抗凝处方，支持高依从率。
ImportanceThe 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.ObjectiveTo 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 ParticipantsA prospective single arm study of 939 consecutive patients treated at a large tertiary healthcare system.ExposuresAn electronic support system comprising 1) an electronic alert to identify patients with AF or atrial flutter, a CHA2DS2-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 MeasuresThe 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.ResultsBetween 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 CHA2DS2-VASc score ≥2 who were not on oral anticoagulation. The median CHA2DS2-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 RelevanceAn 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.