Electronic Decision support for Improvement of Contemporary Therapy for Stroke Prevention

Seemant Chaturvedi, Adam G. Kelly, Shyam Prabhakaran, Gustavo Saposnik, Lilly Lee, Amer Malik, Christine Boerman, Gayle Serlin, Alejandro M. Mantero

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Despite ample clinical trial data demonstrating that oral anticoagulation (OAC) treatment is highly effective in reducing stroke for patients with atrial fibrillation (AF), OAC treatment remains underutilized in current clinical practice. Targeting hospitalist and emergency department providers with electronic decision support represents a potential quality improvement opportunity in the use of OAC medication in AF patients. Methods: We conducted a 3-center study in which 2 sites utilized an electronic alert (EA) embedded in the electronic health record and 1 site provided usual care. The EA calculated the CHA2DS2-VASc score for clinicians. Patients were tracked following discharge from either the emergency department or hospital. We hypothesized that the EA would increase the rate of OAC use by 15% compared to usual care, with a study sample size of 360 patients. Study exclusions included severe heart valve disease, advanced renal disease, and severe dementia. The primary endpoint was OAC use at the time of hospital discharge or 30 days after hospital discharge (whichever was the last observation recorded). Results: Among 309 patients included for analysis (mean age 70.2 years), the median CHA2DS2-VASc score was 3.5. The frequency of OAC use at follow-up at the usual care hospital was 55.9% (95% confidence interval 47.4-67.9). At the 2 EA sites, the rate of OAC use at the last observation point was 43.9% (P = .06). Aspirin use at follow-up was similar at the usual care site and the EA sites (53.8% versus 46.3%). The rate of OAC use in patients greater than 75 years was 60.0% in the usual care site and 48.4% (P = .09) at the EA sites. Conclusions: The EA in our study was not sufficient to ameliorate therapeutic inertia in the use of OAC for stroke prevention in AF.

Original languageEnglish (US)
JournalJournal of Stroke and Cerebrovascular Diseases
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Stroke
Atrial Fibrillation
Hospital Emergency Service
Therapeutics
Hospitalists
Observation
Heart Valve Diseases
Electronic Health Records
Quality Improvement
Sample Size
Aspirin
Dementia
Clinical Trials
Confidence Intervals
Kidney

Keywords

  • Atrial fibrillation
  • cardioembolism
  • electronic alerts
  • embolic stroke
  • ischemic stroke

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Electronic Decision support for Improvement of Contemporary Therapy for Stroke Prevention. / Chaturvedi, Seemant; Kelly, Adam G.; Prabhakaran, Shyam; Saposnik, Gustavo; Lee, Lilly; Malik, Amer; Boerman, Christine; Serlin, Gayle; Mantero, Alejandro M.

In: Journal of Stroke and Cerebrovascular Diseases, 01.01.2018.

Research output: Contribution to journalArticle

Chaturvedi, Seemant ; Kelly, Adam G. ; Prabhakaran, Shyam ; Saposnik, Gustavo ; Lee, Lilly ; Malik, Amer ; Boerman, Christine ; Serlin, Gayle ; Mantero, Alejandro M. / Electronic Decision support for Improvement of Contemporary Therapy for Stroke Prevention. In: Journal of Stroke and Cerebrovascular Diseases. 2018.
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abstract = "Background: Despite ample clinical trial data demonstrating that oral anticoagulation (OAC) treatment is highly effective in reducing stroke for patients with atrial fibrillation (AF), OAC treatment remains underutilized in current clinical practice. Targeting hospitalist and emergency department providers with electronic decision support represents a potential quality improvement opportunity in the use of OAC medication in AF patients. Methods: We conducted a 3-center study in which 2 sites utilized an electronic alert (EA) embedded in the electronic health record and 1 site provided usual care. The EA calculated the CHA2DS2-VASc score for clinicians. Patients were tracked following discharge from either the emergency department or hospital. We hypothesized that the EA would increase the rate of OAC use by 15{\%} compared to usual care, with a study sample size of 360 patients. Study exclusions included severe heart valve disease, advanced renal disease, and severe dementia. The primary endpoint was OAC use at the time of hospital discharge or 30 days after hospital discharge (whichever was the last observation recorded). Results: Among 309 patients included for analysis (mean age 70.2 years), the median CHA2DS2-VASc score was 3.5. The frequency of OAC use at follow-up at the usual care hospital was 55.9{\%} (95{\%} confidence interval 47.4-67.9). At the 2 EA sites, the rate of OAC use at the last observation point was 43.9{\%} (P = .06). Aspirin use at follow-up was similar at the usual care site and the EA sites (53.8{\%} versus 46.3{\%}). The rate of OAC use in patients greater than 75 years was 60.0{\%} in the usual care site and 48.4{\%} (P = .09) at the EA sites. Conclusions: The EA in our study was not sufficient to ameliorate therapeutic inertia in the use of OAC for stroke prevention in AF.",
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AU - Chaturvedi, Seemant

AU - Kelly, Adam G.

AU - Prabhakaran, Shyam

AU - Saposnik, Gustavo

AU - Lee, Lilly

AU - Malik, Amer

AU - Boerman, Christine

AU - Serlin, Gayle

AU - Mantero, Alejandro M.

PY - 2018/1/1

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N2 - Background: Despite ample clinical trial data demonstrating that oral anticoagulation (OAC) treatment is highly effective in reducing stroke for patients with atrial fibrillation (AF), OAC treatment remains underutilized in current clinical practice. Targeting hospitalist and emergency department providers with electronic decision support represents a potential quality improvement opportunity in the use of OAC medication in AF patients. Methods: We conducted a 3-center study in which 2 sites utilized an electronic alert (EA) embedded in the electronic health record and 1 site provided usual care. The EA calculated the CHA2DS2-VASc score for clinicians. Patients were tracked following discharge from either the emergency department or hospital. We hypothesized that the EA would increase the rate of OAC use by 15% compared to usual care, with a study sample size of 360 patients. Study exclusions included severe heart valve disease, advanced renal disease, and severe dementia. The primary endpoint was OAC use at the time of hospital discharge or 30 days after hospital discharge (whichever was the last observation recorded). Results: Among 309 patients included for analysis (mean age 70.2 years), the median CHA2DS2-VASc score was 3.5. The frequency of OAC use at follow-up at the usual care hospital was 55.9% (95% confidence interval 47.4-67.9). At the 2 EA sites, the rate of OAC use at the last observation point was 43.9% (P = .06). Aspirin use at follow-up was similar at the usual care site and the EA sites (53.8% versus 46.3%). The rate of OAC use in patients greater than 75 years was 60.0% in the usual care site and 48.4% (P = .09) at the EA sites. Conclusions: The EA in our study was not sufficient to ameliorate therapeutic inertia in the use of OAC for stroke prevention in AF.

AB - Background: Despite ample clinical trial data demonstrating that oral anticoagulation (OAC) treatment is highly effective in reducing stroke for patients with atrial fibrillation (AF), OAC treatment remains underutilized in current clinical practice. Targeting hospitalist and emergency department providers with electronic decision support represents a potential quality improvement opportunity in the use of OAC medication in AF patients. Methods: We conducted a 3-center study in which 2 sites utilized an electronic alert (EA) embedded in the electronic health record and 1 site provided usual care. The EA calculated the CHA2DS2-VASc score for clinicians. Patients were tracked following discharge from either the emergency department or hospital. We hypothesized that the EA would increase the rate of OAC use by 15% compared to usual care, with a study sample size of 360 patients. Study exclusions included severe heart valve disease, advanced renal disease, and severe dementia. The primary endpoint was OAC use at the time of hospital discharge or 30 days after hospital discharge (whichever was the last observation recorded). Results: Among 309 patients included for analysis (mean age 70.2 years), the median CHA2DS2-VASc score was 3.5. The frequency of OAC use at follow-up at the usual care hospital was 55.9% (95% confidence interval 47.4-67.9). At the 2 EA sites, the rate of OAC use at the last observation point was 43.9% (P = .06). Aspirin use at follow-up was similar at the usual care site and the EA sites (53.8% versus 46.3%). The rate of OAC use in patients greater than 75 years was 60.0% in the usual care site and 48.4% (P = .09) at the EA sites. Conclusions: The EA in our study was not sufficient to ameliorate therapeutic inertia in the use of OAC for stroke prevention in AF.

KW - Atrial fibrillation

KW - cardioembolism

KW - electronic alerts

KW - embolic stroke

KW - ischemic stroke

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