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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Effect of an artificial intelligence-assisted tool on non-valvular atrial fibrillation anticoagulation management in
Xueying Ru1, Lan Zhu1,2, Yunhui Ma1
1Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China.
Insights
This study evaluated an AI-assisted clinical decision support system (CDSS) for atrial fibrillation (AF) management in primary care. The CDSS improved guideline adherence and physician capabilities, offering potential health-economic benefits.
Area of Science:
- Cardiology
- Artificial Intelligence in Healthcare
- Primary Care Medicine
Background:
- Atrial fibrillation (AF) is a common cardiac arrhythmia requiring effective thromboembolic prophylaxis.
- General practitioners (GPs) may have limited knowledge and enthusiasm for managing AF.
- AI-assisted Clinical Decision Support Systems (CDSS) can aid primary care providers (PCPs) in making informed clinical decisions.
Purpose of the Study:
- To determine if promoting CDSS improves primary care for AF patients.
- To assess the health-economic and clinical benefits of CDSS implementation.
- To evaluate the enhancement of GPs' AF management capabilities.
Main Methods:
- A prospective cluster randomized controlled trial involving 14 community health centers in Shanghai.
- Intervention group used CDSS for AF consultations; control group received usual care.
- 498 AF patients included with a 12-month follow-up; intention-to-treat and per-protocol analyses conducted.
Main Results:
- The primary outcome was the proportion of antithrombotic prescriptions aligned with China's AF guidelines.
- Secondary outcomes included consultation frequency, warfarin INR compliance, stroke morbidity, treatment adherence, and cost-benefit analysis.
- The study aims to identify benefits for patients, physicians, and health economics.
Conclusions:
- The study seeks to establish the benefits of CDSS for AF management in Chinese community health centers.
- Potential improvements in patient care, physician expertise, and economic efficiency are anticipated.
Background:
Atrial fibrillation (AF) is one of the most common cardiac arrhythmia diseases. Thromboembolic prophylaxis plays an essential role in AF therapy, but at present, general practitioners (GPs) are presumed to lack the knowledge and enthusiasm for AF management. Clinical decision support systems (CDSS), assisted by artificial intelligence, help primary care providers (PCPs) make quick, individualized, and correct clinical decisions. This primary aim of the study is to identify whether the promotion of the CDSS would improve the primary care provided to patients with AF. The secondary objectives are mainly to assess the health-economic and clinical benefits from using the CDSS, and the improvement of GPs' AF management capability.
Methods:
This study will be a prospective cluster randomized controlled trial, conducted among 14 community health centers in Shanghai which were randomized as the intervention group and control group in a ratio of 1:1. The intervention group will use the CDSS in the consultation of patients with AF and the control group will maintain their usual care. The trial will include 498 patients with AF and the follow-up period will be 12 months. The primary outcome is set as the proportion of antithrombotic treatment prescriptions in agreement with recommendations in the latest China's AF-related guidelines. The secondary outcomes are the frequency of consultation, the compliance rate of international normalized ratio (INR) in patients with warfarin, stroke morbidity, treatment compliance, medication satisfaction, and the cost-benefit analysis. Per-protocol (PP) analysis and the intention-to-treat (ITT) analysis will be conducted.
Discussion:
This study aims to identify whether the application of CDSS to manage patients with AF in China's community health centers would bring benefits for patients, physicians, and health economics.
Trial Registration:
Registry name: AI (Development and promotion of an AI-assisted tool for NVAF management in primary care); registry number: ChiCTR2100052307; registration date: Nov. 22nd, 2021; http://www.chictr.org.cn/showproj.aspx?proj=133849 .
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