TY - JOUR
T1 - Electronic alerts to initiate anticoagulation dialogue in patients with atrial fibrillation
AU - Gutierrez, J. Antonio
AU - Christian, Ruff T.
AU - Aday, Aaron W.
AU - Gu, Lin
AU - Schulteis, Ryan D.
AU - Shihai, Lu
AU - Petrini, Michaela
AU - Sun, Albert Y.
AU - Swaminathan, Rajesh V.
AU - Katzenberger, Daniel R.
AU - Banerjee, Subhash
AU - Rao, Sunil V.
N1 - Funding Information:
This work was supported by an unrestricted research grant from Boehringer Ingelheim Pharmaceuticals, Inc. Boehringer Ingelheim Pharmaceuticals, Inc had no role in the study design or data collection, analysis, and interpretation of the study. JAG, CTR, and SVR had full access to the data and had final responsibility for the content of the publication. Dr. Aday was supported by the National Institutes of Health under Award Numbers K12 HL133117 and K23 HL151871.
Funding Information:
Dr. CT Ruff discloses the following relationships – Research grant through institution: Anthos, Boehringer Ingelheim, Daiichi Sankyo, AstraZeneca, National Institutes of Health; Honoraria for scientific advisory boards and consulting: Anthos, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Janssen, Pfizer, Portola. Dr. Ruff is a member of the TIMI Study Group, which has received institutional research grant support through Brigham and Women's Hospital from: Abbott, Amgen, Anthos Therapeutics, AstraZeneca, Daiichi-Sankyo, Eisai, Intarcia, MedImmune, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, The Medicines Company, Zora Biosciences.
Publisher Copyright:
© 2021
PY - 2022/3
Y1 - 2022/3
N2 - Importance: 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. Objective: To evaluate the effect of a combined alert intervention and shared decision-making tool to improve prescription rates of oral anticoagulation therapy and adherence. Design, Setting, and Participants: A prospective single arm study of 939 consecutive patients treated at a large tertiary healthcare system. Exposures: 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. Main Outcomes and Measures: 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. Results: 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). Conclusion and Relevance: 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.
AB - Importance: 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. Objective: To evaluate the effect of a combined alert intervention and shared decision-making tool to improve prescription rates of oral anticoagulation therapy and adherence. Design, Setting, and Participants: A prospective single arm study of 939 consecutive patients treated at a large tertiary healthcare system. Exposures: 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. Main Outcomes and Measures: 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. Results: 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). Conclusion and Relevance: 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.
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U2 - 10.1016/j.ahj.2021.11.008
DO - 10.1016/j.ahj.2021.11.008
M3 - Article
C2 - 34808105
AN - SCOPUS:85121805248
SN - 0002-8703
VL - 245
SP - 29
EP - 40
JO - American Heart Journal
JF - American Heart Journal
ER -