Electronic alerts to initiate anticoagulation dialogue in patients with atrial fibrillation
The 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. To evaluate the effect of a combined alert interven...
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| Veröffentlicht in: | The American heart journal 2022-03, Vol.245, p.29-40 |
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| creator | Gutierrez, J. Antonio Christian, Ruff T. Aday, Aaron W. Gu, Lin Schulteis, Ryan D. Shihai, Lu Petrini, Michaela Sun, Albert Y. Swaminathan, Rajesh V. Katzenberger, Daniel R. Banerjee, Subhash Rao, Sunil V. |
| description | The 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.
To evaluate the effect of a combined alert intervention and shared decision-making tool to improve prescription rates of oral anticoagulation therapy and adherence.
A prospective single arm study of 939 consecutive patients treated at a large tertiary healthcare system.
An 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.
The 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.
Between 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).
An 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. |
| doi_str_mv | 10.1016/j.ahj.2021.11.008 |
| format | Article |
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To evaluate the effect of a combined alert intervention and shared decision-making tool to improve prescription rates of oral anticoagulation therapy and adherence.
A prospective single arm study of 939 consecutive patients treated at a large tertiary healthcare system.
An 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.
The 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.
Between 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).
An 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.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2021.11.008</identifier><identifier>PMID: 34808105</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Administration, Oral ; Anticoagulants ; Atrial Fibrillation - complications ; Atrial Fibrillation - drug therapy ; Cardiac arrhythmia ; Decision making ; Electronics ; Enrollments ; Fibrillation ; Flutter ; Health risks ; Humans ; Internet resources ; Patients ; Pharmacy ; Population ; Prospective Studies ; Risk Assessment ; Risk Factors ; Stroke ; Stroke - chemically induced ; Stroke - prevention & control ; Support systems ; Therapy ; Thromboembolism ; Vibration ; Vitamin K ; Warfarin</subject><ispartof>The American heart journal, 2022-03, Vol.245, p.29-40</ispartof><rights>2021</rights><rights>Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Mar 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c479t-3493172f51322092506eec42ebdf1512ab40aedeb3b62f877043d82359d0576f3</citedby><cites>FETCH-LOGICAL-c479t-3493172f51322092506eec42ebdf1512ab40aedeb3b62f877043d82359d0576f3</cites><orcidid>0000-0003-2914-0894 ; 0000-0002-4334-1038 ; 0000-0002-7340-8504 ; 0000-0001-6243-3432 ; 0000-0002-4712-3206</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2627453799?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,315,782,786,887,3552,27931,27932,46002,64392,64396,72476</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34808105$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gutierrez, J. Antonio</creatorcontrib><creatorcontrib>Christian, Ruff T.</creatorcontrib><creatorcontrib>Aday, Aaron W.</creatorcontrib><creatorcontrib>Gu, Lin</creatorcontrib><creatorcontrib>Schulteis, Ryan D.</creatorcontrib><creatorcontrib>Shihai, Lu</creatorcontrib><creatorcontrib>Petrini, Michaela</creatorcontrib><creatorcontrib>Sun, Albert Y.</creatorcontrib><creatorcontrib>Swaminathan, Rajesh V.</creatorcontrib><creatorcontrib>Katzenberger, Daniel R.</creatorcontrib><creatorcontrib>Banerjee, Subhash</creatorcontrib><creatorcontrib>Rao, Sunil V.</creatorcontrib><title>Electronic alerts to initiate anticoagulation dialogue in patients with atrial fibrillation</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>The 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.
To evaluate the effect of a combined alert intervention and shared decision-making tool to improve prescription rates of oral anticoagulation therapy and adherence.
A prospective single arm study of 939 consecutive patients treated at a large tertiary healthcare system.
An 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.
The 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.
Between 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).
An 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.</description><subject>Administration, Oral</subject><subject>Anticoagulants</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Cardiac arrhythmia</subject><subject>Decision making</subject><subject>Electronics</subject><subject>Enrollments</subject><subject>Fibrillation</subject><subject>Flutter</subject><subject>Health risks</subject><subject>Humans</subject><subject>Internet resources</subject><subject>Patients</subject><subject>Pharmacy</subject><subject>Population</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Stroke</subject><subject>Stroke - chemically induced</subject><subject>Stroke - prevention & control</subject><subject>Support systems</subject><subject>Therapy</subject><subject>Thromboembolism</subject><subject>Vibration</subject><subject>Vitamin K</subject><subject>Warfarin</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kUFr3DAQhUVJaTZpf0AvxZCz3RlJlmwChRDStBDopT31IGR5vCvjWBtZTsi_r8Kmobn0JKT53tNjHmMfESoEVJ_Hyu7GigPHCrECaN6wDUKrS6WlPGIbAOBlo0Ecs5NlGfNV8Ua9Y8dCNtAg1Bv2-2oil2KYvSvsRDEtRQqFn33yNlFh5-RdsNt1ssmHuei9ncJ2pUwU-_xEcxY8-LQrbIp5Vgy-i3460O_Z28FOC314Pk_Zr69XPy-_lTc_rr9fXtyUTuo2lUK2AjUfahScQ8trUEROcur6AWvktpNgqadOdIoPjdYgRd9wUbc91FoN4pR9Ofju1-6WepdDRTuZffS3Nj6aYL15PZn9zmzDvWk1iqZW2eDs2SCGu5WWZMawxjlnNlxxLWuh2zZTeKBcDMsSaXj5AcE89WFGk_swT30YRJP7yJpP_0Z7UfwtIAPnB4Dygu49RbO4vFVHvY-5GNMH_x_7Px_MnN8</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Gutierrez, J. Antonio</creator><creator>Christian, Ruff T.</creator><creator>Aday, Aaron W.</creator><creator>Gu, Lin</creator><creator>Schulteis, Ryan D.</creator><creator>Shihai, Lu</creator><creator>Petrini, Michaela</creator><creator>Sun, Albert Y.</creator><creator>Swaminathan, Rajesh V.</creator><creator>Katzenberger, Daniel R.</creator><creator>Banerjee, Subhash</creator><creator>Rao, Sunil V.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-2914-0894</orcidid><orcidid>https://orcid.org/0000-0002-4334-1038</orcidid><orcidid>https://orcid.org/0000-0002-7340-8504</orcidid><orcidid>https://orcid.org/0000-0001-6243-3432</orcidid><orcidid>https://orcid.org/0000-0002-4712-3206</orcidid></search><sort><creationdate>20220301</creationdate><title>Electronic alerts to initiate anticoagulation dialogue in patients with atrial fibrillation</title><author>Gutierrez, J. Antonio ; Christian, Ruff T. ; Aday, Aaron W. ; Gu, Lin ; Schulteis, Ryan D. ; Shihai, Lu ; Petrini, Michaela ; Sun, Albert Y. ; Swaminathan, Rajesh V. ; Katzenberger, Daniel R. ; Banerjee, Subhash ; Rao, Sunil V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c479t-3493172f51322092506eec42ebdf1512ab40aedeb3b62f877043d82359d0576f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Administration, Oral</topic><topic>Anticoagulants</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Cardiac arrhythmia</topic><topic>Decision making</topic><topic>Electronics</topic><topic>Enrollments</topic><topic>Fibrillation</topic><topic>Flutter</topic><topic>Health risks</topic><topic>Humans</topic><topic>Internet resources</topic><topic>Patients</topic><topic>Pharmacy</topic><topic>Population</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Stroke</topic><topic>Stroke - chemically induced</topic><topic>Stroke - prevention & control</topic><topic>Support systems</topic><topic>Therapy</topic><topic>Thromboembolism</topic><topic>Vibration</topic><topic>Vitamin K</topic><topic>Warfarin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gutierrez, J. 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Antonio</au><au>Christian, Ruff T.</au><au>Aday, Aaron W.</au><au>Gu, Lin</au><au>Schulteis, Ryan D.</au><au>Shihai, Lu</au><au>Petrini, Michaela</au><au>Sun, Albert Y.</au><au>Swaminathan, Rajesh V.</au><au>Katzenberger, Daniel R.</au><au>Banerjee, Subhash</au><au>Rao, Sunil V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Electronic alerts to initiate anticoagulation dialogue in patients with atrial fibrillation</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>245</volume><spage>29</spage><epage>40</epage><pages>29-40</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><abstract>The 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.
To evaluate the effect of a combined alert intervention and shared decision-making tool to improve prescription rates of oral anticoagulation therapy and adherence.
A prospective single arm study of 939 consecutive patients treated at a large tertiary healthcare system.
An 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.
The 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.
Between 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).
An 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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34808105</pmid><doi>10.1016/j.ahj.2021.11.008</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-2914-0894</orcidid><orcidid>https://orcid.org/0000-0002-4334-1038</orcidid><orcidid>https://orcid.org/0000-0002-7340-8504</orcidid><orcidid>https://orcid.org/0000-0001-6243-3432</orcidid><orcidid>https://orcid.org/0000-0002-4712-3206</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | The American heart journal, 2022-03, Vol.245, p.29-40 |
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| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9713856 |
| source | MEDLINE; ScienceDirect Journals (5 years ago - present); ProQuest Central UK/Ireland |
| subjects | Administration, Oral Anticoagulants Atrial Fibrillation - complications Atrial Fibrillation - drug therapy Cardiac arrhythmia Decision making Electronics Enrollments Fibrillation Flutter Health risks Humans Internet resources Patients Pharmacy Population Prospective Studies Risk Assessment Risk Factors Stroke Stroke - chemically induced Stroke - prevention & control Support systems Therapy Thromboembolism Vibration Vitamin K Warfarin |
| title | Electronic alerts to initiate anticoagulation dialogue in patients with atrial fibrillation |
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