A new clinical decision support tool for improving the adequacy of anticoagulant therapy and reducing the incidence of stroke in nonvalvular atrial fibrillation
Dalmau Llorca, M. Rosa (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Gonçalves, A. Q. (Universitat Autònoma de Barcelona)
Forcadell Drago, Emma (Equip d'Atenció Primària Ulldecona-La Sénia)
Fernández-Sáez, José (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Hernández Rojas, Zojaina (Institut Català de la Salut)
Pepió, Josep M. (Institut Català de la Salut)
Rodríguez, Dolores (Universitat Autònoma de Barcelona)
Morral Parente, Rosa Maria (Institut Català de la Salut)
Aguilar Martín, Carina (Institut Català de la Salut)

Date:	2018
Abstract:	Atrial fibrillation (AF) is the most common cardiac arrhythmia and increases the risk of ischemic stroke 4 to 5-fold. The first choice of anticoagulant therapy (AT) is the vitamin K antagonist (VKA). Contraindication to VKA or poor control of the International Normalized Ratio leads to the administration of direct-acting oral anticoagulants. There is a trend toward inadequate AT in nonvalvular AF (NVAF) patients. Aim: To evaluate the impact of the implementation of a decision support tool linked to the digital clinical history on the adequacy of AT, the incidence of complications, and the mortality in patients with NVAF in primary care centers (PCCs) of the Catalan Institute of Health (ICS). Randomized clinical trial in 287 PCCs, formed by 2 groups (intervention and control). Population: patients controlled in PCCs, diagnosed with NVAF 1 year before the implementation of the decision support tool and with VKA treatment over a minimum of 1 year. A simple randomization method will be performed at a sector level. The decision support tool will be available for 1 year. The time in therapeutic range (TTR) will be available in the digital clinical history only to professionals of the intervention group. The information system for primary care research development database will be used for the data extraction. Statistical analysis will be done at 3 time points: before the implementation of the tool, at 1 year, and at 2 years after the beginning of the intervention. Multilevel (patient and professional levels) logistic regression models will be used to estimate the effect of the intervention. This study protocol was approved by the Ethical Committee of Clinical Investigation of the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (code P17/091). Articles will be published in scientific journals. Clinical-Trials. gov: NCT03367325.
Note:	Altres ajuts: Pla estratègic de recerca i innovació en salut (PERIS) - Subvencions per a projectes de recerca orientats a l'atenció primària), grant number SLT002/16/00146.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Anticoagulants ; Atrial fibrillation ; Clinical decision support systems ; Incidence ; Primary health care ; Randomized controlled trial ; Stroke
Published in:	Medicine, Vol. 97, Issue 3 (January 2018) , art. e9578, ISSN 1536-5964

DOI: 10.1097/MD.0000000000009578
PMID: 29504981

6 p, 246.1 KB

The record appears in these collections:
Articles > Research articles
Articles > Published articles