Application of a Decision Support Tool for Anticoagulation in Patients with Non-valvular Atrial Fibrillation

Wess, Mark; Schauer, Daniel P.; Johnston, Joseph A.; Moomaw, Charles J.; Brewer, David E.; Cook, E. Francis; Eckman, Mark H.

doi:10.1007/s11606-007-0477-9

Cited by 26 publications

(15 citation statements)

References 56 publications

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“…This will allow for more accurate research and will enable the use of decision support systems to support caretakers in applying complex guidelines. Decision support systems might play a vital role in the improvement of stroke prevention, as has been stated and validated in other areas of medicine [21], [22]. Further research should be done to assess the use of these systems in medical practice, as clues from the medical history seem to be easily overlooked.…”

Section: Discussionmentioning

confidence: 97%

Frequency and Risk Factors for Under- and Over-Treatment in Stroke Prevention for Patients with Non-Valvular Atrial Fibrillation in General Practice

et al. 2013

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ObjectiveTo determine adequacy of antithrombotic treatment in patients with non-valvular atrial fibrillation. To determine risk factors for under- and over-treatment.DesignRetrospective, cross-sectional study of electronic health records from 36 general practitioners in 2008.SettingGeneral practice in the Netherlands.SubjectsPrimary care physicians (n = 36) and patients (n = 981) aged 65 years and over.Main Outcome MeasuresRates of adequate, under and over-treatment, risk factors for under and over-treatment.ResultsOf the 981 included patients with a mean of age 78, 18% received no antithrombotic treatment (under-treatment), 13% received antiplatelet drugs and 69% received oral anticoagulation (OAC). Further, 43% of the included patients were treated adequately, 26% were under-treated, and 31% were over-treated. Patients with a previous ischaemic stroke were at high risk for under-treatment (OR 2.4, CI 1.6–3.5), whereas those with contraindications for OAC were at high risk for over-treatment (OR 37.0, CI 18.1–79.9). Age over 75 (OR 0.2, CI: 0.1–0.3]), diabetes (OR 0.1, CI: 0.1–0.3), heart failure (OR 0.2, CI: 0.1–0.3), hypertension (OR 0.1, CI: 0.1–0.2) and previous ischaemic stroke (OR 0.04, CI: 0.02–0.11) protected against over-treatment.ConclusionsIn general practice, CHADS2-criteria are being used, but the antithrombotic treatment of patients with atrial fibrillation frequently deviates from guidelines on this topic. Patients with previous stroke are at high risk of not being prescribed OAC. Contraindications for OAC, however, seem to be frequently overlooked.

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Section: Discussionmentioning

confidence: 97%

Frequency and Risk Factors for Under- and Over-Treatment in Stroke Prevention for Patients with Non-Valvular Atrial Fibrillation in General Practice

et al. 2013

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“…But it is not yet that straightforward. For example, in a study of automated stroke and bleeding risk determination for patients with atrial fibrillation, although the decision support tool in this study recommended warfarin 49% of the time, it was only utilized in 10% of the patients (31). This suggests either that clinicians have a way to go to feel comfortable trusting automated support, or that algorithms are not yet able to capture many nuances of clinical decision-making.…”

Section: Improving Physician Carementioning

confidence: 99%

Moving From Digitalization to Digitization in Cardiovascular Care

Steinhubl

Topol

2015

Journal of the American College of Cardiology

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So far, the digitization of health care is best exemplified by electronic medical records, which have been far from favorably or uniformly accepted. However, properly implemented digitization can enable better patient outcomes, improve convenience, potentially lower health care costs, and possibly lead to much greater physician satisfaction. Precision (also known as personalized or individualized) medicine is frequently discussed today, but, in reality, it is what physicians have attempted to do as best they could for millennia. But now we have new tools that can begin to give us a much more high-definition view of our patients; from affordable and rapid genetic testing to wearable sensors that track a wide range of important physiologic parameters continuously. Although seemingly counterintuitive, the digitization of health care can also markedly improve the physician-patient relationship, allowing more time for human interaction when care is bolstered by digital technologies that better individualize diagnostics and treatments.

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“…Previous studies have investigated preferences specific to warfarin and/or aspirin [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33], thus a key gap in the literature is information on preferences incorporating attributes associated with the NOACs [34]. The existing literature, which used an attributed-based trade-off method (the probability trade-off method) [30][31][32][33], most of which is over 10 years old, investigated choice between two alternatives varying one attribute at a time (usually stroke risk or bleed risk).…”

Section: Introductionmentioning

confidence: 99%

Preferences for Oral Anticoagulants in Atrial Fibrillation: a Best–Best Discrete Choice Experiment

2014

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Application of a Decision Support Tool for Anticoagulation in Patients with Non-valvular Atrial Fibrillation

Cited by 26 publications

References 56 publications

Frequency and Risk Factors for Under- and Over-Treatment in Stroke Prevention for Patients with Non-Valvular Atrial Fibrillation in General Practice

Frequency and Risk Factors for Under- and Over-Treatment in Stroke Prevention for Patients with Non-Valvular Atrial Fibrillation in General Practice

Moving From Digitalization to Digitization in Cardiovascular Care

Preferences for Oral Anticoagulants in Atrial Fibrillation: a Best–Best Discrete Choice Experiment

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