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Effectiveness of CHA

S van Doorn1, F H Rutten1, C M O'Flynn1

  • 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 AB Utrecht, the Netherlands.

International Journal of Cardiology
|September 19, 2018
PubMed

Insights

Automated decision support for atrial fibrillation (AF) patients did not lower stroke risk. This study found no significant difference in stroke incidence, bleeding, or anticoagulant use between intervention and usual care groups.

Area of Science:

  • Cardiology
  • General Practice
  • Health Informatics

Background:

  • Atrial fibrillation (AF) guidelines recommend the CHA2DS2-VASc score for anticoagulant decisions.
  • Underuse of anticoagulation in AF patients remains a concern.
  • This study investigated automated decision support to improve stroke prevention in AF.

Purpose of the Study:

  • To evaluate the impact of an automated CHA2DS2-VASc based decision support system on stroke prevention in general practice patients with AF.
  • To assess the effect on ischaemic stroke, transient ischaemic attack (TIA), and thromboembolism (TE) incidence.
  • To analyze secondary outcomes including bleeding rates and anticoagulant use.

Main Methods:

  • A cluster randomised trial was conducted in general practices.
  • Intervention practices received CHA2DS2-VASc based anticoagulant treatment recommendations.
  • Reference practices provided usual care; primary outcome was ischaemic stroke/TIA/TE incidence.

Main Results:

  • 1129 AF patients in intervention and 1226 in reference groups were studied.
  • Median follow-up was 2.7 years; incidence of stroke/TIA/TE was 1.96/100 person-years (intervention) vs. 1.42/100 person-years (reference) (HR 1.3, 95% C.I. 0.8-2.1).
  • No significant differences were found in bleeding rates or anticoagulant over/underuse.

Conclusions:

  • Underuse of anticoagulants in AF patients in general practice was low.
  • CHA2DS2-VASc based decision support did not reduce stroke incidence.
  • The intervention did not impact bleeding risk or anticoagulant prescribing patterns.
Abstract

Keywords:
AnticoagulantsAtrial fibrillationCHA(2)DS(2)-VAScDecision support system

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