An automated software system to promote anticoagulation and reduce stroke risk: cluster-randomized controlled trial

Background and Purpose: Oral anticoagulants (OAC) substantially reduce risk of stroke in atrial fibrillation, but uptake is suboptimal. Electronic health records enable automated identification of people at risk but not receiving treatment. We investigated the effectiveness of a software tool (AUR...

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Main Authors:	Holt, Tim A., Dalton, Andrew, Marshall, Tom, Fay, Matthew, Qureshi, Nadeem, Kirkpatrick, Susan, Hislop, Jenny, Lasserson, Daniel, Kearley, Karen, Mollison, Jill, Yu, Ly-Mee, Hobbs, F.D. Richard, Fitzmaurice, David
Format:	Article
Language:	English
Published:	American Heart Association 2017
Online Access:	http://eprints.nottingham.ac.uk/45011/ http://eprints.nottingham.ac.uk/45011/ http://eprints.nottingham.ac.uk/45011/1/Holt%20Stroke%202017%20AAM.pdf

id	nottingham-45011
recordtype	eprints
spelling	nottingham-450112017-10-18T17:50:55Z http://eprints.nottingham.ac.uk/45011/ An automated software system to promote anticoagulation and reduce stroke risk: cluster-randomized controlled trial Holt, Tim A. Dalton, Andrew Marshall, Tom Fay, Matthew Qureshi, Nadeem Kirkpatrick, Susan Hislop, Jenny Lasserson, Daniel Kearley, Karen Mollison, Jill Yu, Ly-Mee Hobbs, F.D. Richard Fitzmaurice, David Background and Purpose: Oral anticoagulants (OAC) substantially reduce risk of stroke in atrial fibrillation, but uptake is suboptimal. Electronic health records enable automated identification of people at risk but not receiving treatment. We investigated the effectiveness of a software tool (AURAS-AF [Automated Risk Assessment for Stroke in Atrial Fibrillation]) designed to identify such individuals during routine care through a cluster-randomized trial. Methods: Screen reminders appeared each time the electronic health records of an eligible patient was accessed until a decision had been taken over OAC treatment. Where OAC was not started, clinicians were prompted to indicate a reason. Control practices continued usual care. The primary outcome was the proportion of eligible individuals receiving OAC at 6 months. Secondary outcomes included rates of cardiovascular events and reports of adverse effects of the software on clinical decision-making. Results: Forty-seven practices were randomized. The mean proportion–prescribed OAC at 6 months was 66.3% (SD=9.3) in the intervention arm and 63.9% (9.5) in the control arm (adjusted difference 1.21% [95% confidence interval −0.72 to 3.13]). Incidence of recorded transient ischemic attack was higher in the intervention practices (median 10.0 versus 2.3 per 1000 patients with atrial fibrillation; P=0.027), but at 12 months, we found a lower incidence of both all cause stroke (P=0.06) and hemorrhage (P=0.054). No adverse effects of the software were reported. Conclusions: No significant change in OAC prescribing occurred. A greater rate of diagnosis of transient ischemic attack (possibly because of improved detection or overdiagnosis) was associated with a reduction (of borderline significance) in stroke and hemorrhage over 12 months. Clinical Trial Registration: URL: http://www.isrctn.com. Unique Identifier: ISRCTN55722437.%U http://stroke.ahajournals.org/content/strokeaha/early/2017/01/24/STROKEAHA.116.015468.full.pdf American Heart Association 2017-01-24 Article PeerReviewed application/pdf en http://eprints.nottingham.ac.uk/45011/1/Holt%20Stroke%202017%20AAM.pdf Holt, Tim A. and Dalton, Andrew and Marshall, Tom and Fay, Matthew and Qureshi, Nadeem and Kirkpatrick, Susan and Hislop, Jenny and Lasserson, Daniel and Kearley, Karen and Mollison, Jill and Yu, Ly-Mee and Hobbs, F.D. Richard and Fitzmaurice, David (2017) An automated software system to promote anticoagulation and reduce stroke risk: cluster-randomized controlled trial. Stroke, 48 (3). pp. 787-790. ISSN 1524-4628 http://stroke.ahajournals.org/content/early/2017/01/24/STROKEAHA.116.015468.long
repository_type	Digital Repository
institution_category	Local University
institution	University of Nottingham Malaysia Campus
building	Nottingham Research Data Repository
collection	Online Access
language	English
description	Background and Purpose: Oral anticoagulants (OAC) substantially reduce risk of stroke in atrial fibrillation, but uptake is suboptimal. Electronic health records enable automated identification of people at risk but not receiving treatment. We investigated the effectiveness of a software tool (AURAS-AF [Automated Risk Assessment for Stroke in Atrial Fibrillation]) designed to identify such individuals during routine care through a cluster-randomized trial. Methods: Screen reminders appeared each time the electronic health records of an eligible patient was accessed until a decision had been taken over OAC treatment. Where OAC was not started, clinicians were prompted to indicate a reason. Control practices continued usual care. The primary outcome was the proportion of eligible individuals receiving OAC at 6 months. Secondary outcomes included rates of cardiovascular events and reports of adverse effects of the software on clinical decision-making. Results: Forty-seven practices were randomized. The mean proportion–prescribed OAC at 6 months was 66.3% (SD=9.3) in the intervention arm and 63.9% (9.5) in the control arm (adjusted difference 1.21% [95% confidence interval −0.72 to 3.13]). Incidence of recorded transient ischemic attack was higher in the intervention practices (median 10.0 versus 2.3 per 1000 patients with atrial fibrillation; P=0.027), but at 12 months, we found a lower incidence of both all cause stroke (P=0.06) and hemorrhage (P=0.054). No adverse effects of the software were reported. Conclusions: No significant change in OAC prescribing occurred. A greater rate of diagnosis of transient ischemic attack (possibly because of improved detection or overdiagnosis) was associated with a reduction (of borderline significance) in stroke and hemorrhage over 12 months. Clinical Trial Registration: URL: http://www.isrctn.com. Unique Identifier: ISRCTN55722437.%U http://stroke.ahajournals.org/content/strokeaha/early/2017/01/24/STROKEAHA.116.015468.full.pdf
format	Article
author	Holt, Tim A. Dalton, Andrew Marshall, Tom Fay, Matthew Qureshi, Nadeem Kirkpatrick, Susan Hislop, Jenny Lasserson, Daniel Kearley, Karen Mollison, Jill Yu, Ly-Mee Hobbs, F.D. Richard Fitzmaurice, David
spellingShingle	Holt, Tim A. Dalton, Andrew Marshall, Tom Fay, Matthew Qureshi, Nadeem Kirkpatrick, Susan Hislop, Jenny Lasserson, Daniel Kearley, Karen Mollison, Jill Yu, Ly-Mee Hobbs, F.D. Richard Fitzmaurice, David An automated software system to promote anticoagulation and reduce stroke risk: cluster-randomized controlled trial
author_facet	Holt, Tim A. Dalton, Andrew Marshall, Tom Fay, Matthew Qureshi, Nadeem Kirkpatrick, Susan Hislop, Jenny Lasserson, Daniel Kearley, Karen Mollison, Jill Yu, Ly-Mee Hobbs, F.D. Richard Fitzmaurice, David
author_sort	Holt, Tim A.
title	An automated software system to promote anticoagulation and reduce stroke risk: cluster-randomized controlled trial
title_short	An automated software system to promote anticoagulation and reduce stroke risk: cluster-randomized controlled trial
title_full	An automated software system to promote anticoagulation and reduce stroke risk: cluster-randomized controlled trial
title_fullStr	An automated software system to promote anticoagulation and reduce stroke risk: cluster-randomized controlled trial
title_full_unstemmed	An automated software system to promote anticoagulation and reduce stroke risk: cluster-randomized controlled trial
title_sort	automated software system to promote anticoagulation and reduce stroke risk: cluster-randomized controlled trial
publisher	American Heart Association
publishDate	2017
url	http://eprints.nottingham.ac.uk/45011/ http://eprints.nottingham.ac.uk/45011/ http://eprints.nottingham.ac.uk/45011/1/Holt%20Stroke%202017%20AAM.pdf
first_indexed	2018-09-06T13:37:46Z
last_indexed	2018-09-06T13:37:46Z
_version_	1610865512616558592

An automated software system to promote anticoagulation and reduce stroke risk: cluster-randomized controlled trial

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