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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| Format: | Article |
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American Heart Association
2017
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| Online Access: | https://eprints.nottingham.ac.uk/45011/ |
| _version_ | 1848797048095113216 |
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| 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 |
| 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. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| 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 |
| first_indexed | 2025-11-14T19:57:40Z |
| format | Article |
| id | nottingham-45011 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:57:40Z |
| publishDate | 2017 |
| publisher | American Heart Association |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-450112020-05-04T18:29:39Z https://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 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 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 Atrial Fibrillation; Primary Prevention; Health Services; Stroke; Electronic Health Records; Reminder Systems; Anticoagulants. http://stroke.ahajournals.org/content/early/2017/01/24/STROKEAHA.116.015468.long |
| spellingShingle | Atrial Fibrillation; Primary Prevention; Health Services; Stroke; Electronic Health Records; Reminder Systems; Anticoagulants. 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 |
| title | 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_short | 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 |
| topic | Atrial Fibrillation; Primary Prevention; Health Services; Stroke; Electronic Health Records; Reminder Systems; Anticoagulants. |
| url | https://eprints.nottingham.ac.uk/45011/ https://eprints.nottingham.ac.uk/45011/ |