Automated Software System to Promote Anticoagulation and Reduce Stroke Risk: Cluster-Randomized Controlled Trial

Area of Science:

• Cardiology
• Health Informatics
• Clinical Trials

Background:

• Oral anticoagulants (OAC) are crucial for reducing stroke risk in atrial fibrillation (AF).
• Suboptimal OAC uptake remains a challenge in AF management.
• Electronic health records (EHRs) can identify at-risk patients lacking OAC treatment.

Purpose of the Study:

• To evaluate the effectiveness of the AURAS-AF software tool in identifying and facilitating OAC treatment for AF patients.
• To assess the impact of automated risk assessment on OAC prescribing rates during routine care.

Main Methods:

• A cluster-randomized trial involving 47 practices.
• Intervention group received EHR screen reminders for OAC decisions.
• Control group received usual care.
• Primary outcome: OAC prescribing proportion at 6 months.

Main Results:

• No significant difference in OAC prescribing proportion between intervention (66.3%) and control (63.9%) groups.
• Higher incidence of transient ischemic attack (TIA) diagnoses in the intervention group (P=0.027).
• Borderline significant reduction in all-cause stroke (P=0.06) and hemorrhage (P=0.054) at 12 months.
• No adverse software effects reported.

Conclusions:

• The AURAS-AF tool did not significantly increase OAC prescribing rates.
• Increased TIA diagnoses may indicate improved detection or overdiagnosis.
• The tool showed a trend towards reducing stroke and hemorrhage events.