OBJECTIVE:
To develop an electronic decision support tool for anticoagulation and stroke prevention in patients with atrial fibrillation (AF) and demonstrate its efficacy through a randomized cluster controlled trial.
BACKGROUND:
Despite good evidence of the benefits of anticoagulation in preventing stroke in patients with AF, doctors are often reluctant to prescribe anticoagulation citing fear of patient falls and risk of bleeding.
A recent audit of stroke care in New Zealand revealed that among patients presenting with an acute ischaemic stroke, 40[percnt] had a known history of AF, however, only 24[percnt] of patients with AF were on anti-coagulants. Two audits confirmed the low use of anticoagulation in patients presenting to Wellington Hospital.
While AF is considered a disease of the heart, the end organ damage of stroke falls in the domain of the neurologist. We plan to address the low rates of anticoagulation through an electronic decision support (EDS) tool in order to reduce the rate of stroke.
DESIGN/METHODS:
Medtech is a patient management system used by 95[percnt] of primary care practices in New Zealand. We partnered with Best Practice Advocacy Centre (bpacNZ) and created a fully integrated EDS tool for anticoagulation and AF management.
RESULTS:
The EDS tool delivers prompts, support and guidance to the primary care physician for establishing a patient on anticoagulation whenever AF is identified. We plan a randomised cluster controlled trial, randomising primary care practices to either the intervention arm (EDS tool) or a control arm (current best practice), to prove efficacy of the EDS tool for increasing anticoagulation rates.
CONCLUSIONS:
Given that the existing technology base is well established nationwide, it is expected that this could become a national model which would have significant benefits for patient care and healthcare costs across the country. Disclosure: Dr. Jolliffe has nothing to disclose. Dr. Rosemergy has nothing to disclose. Dr. Lanford has nothing to disclose. Dr. Abernethy has nothing to disclose. Dr. Ranta has nothing to disclose.
OBJECTIVE:
To implement a dedicated neurology led clinic for the acute assessment and initiation of anticoagulation in patients with atrial fibrillation (AF).
BACKGROUND:
Despite the presence of good evidence for the benefits of anticoagulation in preventing stroke in patients with AF, doctors are often reluctant to prescribe anticoagulation citing fear of patient falls and risk of bleeding.
A recent audit of stroke care in New Zealand revealed that among patients presenting with an acute ischaemic stroke, 40[percnt] had a known history of AF, however, only 24[percnt] of patients with AF were on anti-coagulants. Two audits confirmed the low use of anticoagulation in patients presenting to Wellington Hospital.
DESIGN/METHODS:
The Neurology service established a dedicated AF Anticoagulation Clinic to acutely assess any patient with AF and initiate anticoagulation if appropriate. Referrals were accepted for patients discharged directly any hospital department including the Emergency Department.
RESULTS:
36 referrals were received over six months. Most were assessed within one week. 11/36 had persistent or permanent AF, 23/36 had paroxysmal AF and 3/36 had isolated AF.
24/36 had CHA2DS2-VASc score 蠅 2 and were eligible for treatment. The median CHA2DS2-VASc score was 4.
23/36 were on antiplatelet medications. Only 2/36 had an absolute contraindication to anticoagulation. Anticoagulation was started in 22/24 eligible patients (91.6[percnt]). All were started on novel oral anticoagulants, with 16/22 starting Dabigatran and 6/22 starting Rivaroxaban.
14/36 were not anticoagulated, 7 due to low CHA2DS2-VASc score, 5 due to patient preference and 2 due to absolute contraindications.
CONCLUSIONS:
This confirms the feasibility of a dedicated AF anticoagulation clinic and it’s ability to significantly increase anticoagulation rates among patients with AF. The intention is to expand this service to primary care initially through engagement in a cluster randomized trial (see next poster). Disclosure: Dr. Jolliffe has nothing to disclose. Dr. Rosemergy has nothing to disclose. Dr. Lanford has nothing to disclose. Dr. Abernethy has nothing to disclose.
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