Abstract
Only half of atrial fibrillation (AF) patients with elevated stroke risk receive anticoagulation (AC). Electronic health record (EHR) alerts have the potential to close the gap. We designed an outpatient EHR alert (linked to an order set for ordering AC, labs, and specialty referrals) that fired when cardiology and primary care providers (PCPs) saw AF patients not on AC. We assigned all untreated patients seen by cardiology providers and PCPs in the 8 months before and after the alert launch to pre- and post-launch intervention cohorts, respectively. Untreated AF patients seeing other types of providers became controls. We then compared the difference in AC starts between intervention and control patients post-launch to the same difference prelaunch (adjusting for covariates). We measured alert responsiveness as how often patients had at least one encounter with a provider, who interacted with the alert. The adjusted percentage of AC starts for the prelaunch cohort was 20% for intervention patients and 17% for controls (difference = 3%); post-launch, the percentage was 13% for both post-launch intervention and controls (difference = 0%). The difference in difference was − 3% (p value 0.63). For half of patients, at least one provider was responsive to our alert. Reasons for no AC commonly included relative contraindications (e.g. fall, gastrointestinal bleed). Our alert did not increase AC starts but responsiveness to it was high. Increasing AC starts will likely require education surrounding relative contraindications.
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AK, DM and GM contributed to the study conception and design. Material preparation, data collection and analysis work was performed by AK, HS, LH, QS, SC. The first draft of the manuscript was written by HS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Dr. McManus reports grants from Bristol-Meyers Squibb, grants from Pfizer, grants from Boeringher-Ingelheim, grants from Apple, grants from Samsung, grants from Philips Healthcare, grants from Biotronik, personal fees from Bristol-Meyers Squibb, personal fees from Pfizer, personal fees from Flexcon, personal fees from Boston Biomedical Associates, other from Mobile Sense Technologies, LLC, grants from National Institutes of Health, outside the submitted work. Dr. Kapoor reports grants from Bristol-Meyers Squibb and grants from Pfizer outside the submitted work. All remaining authors have nothing to disclose.
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The Institutional Review Board at the University of Massachusetts Medical School approved this study and waived inform consent of participants given we used a retrospective quasi-experimental design.
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Sadiq, H., Hoque, L., Shi, Q. et al. SUPPORT‐AF III: supporting use of AC through provider prompting about oral anticoagulation therapy for AF. J Thromb Thrombolysis 52, 808–816 (2021). https://doi.org/10.1007/s11239-021-02420-8
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DOI: https://doi.org/10.1007/s11239-021-02420-8