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Updated: Jul 19, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Can a best practice advisory improve anticoagulation prescribing to reduce stroke risk in patients with atrial
Mark H Eckman1, Ruth Wise1, Carol Knochelmann2
1Division of General Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Insights
A best practice advisory (BPA) improved anticoagulation therapy for atrial fibrillation (AF) patients. This electronic health record tool increased appropriate thromboprophylaxis, reducing stroke risk in primary care settings.
Area of Science:
- Cardiology
- Health Informatics
- Clinical Decision Support
Background:
- Atrial fibrillation (AF) is a common heart rhythm disorder and a significant stroke risk factor.
- Anticoagulation therapy is proven to reduce stroke risk in AF patients, yet it is underutilized.
- A practice gap exists in the optimal management of anticoagulation for AF patients.
Purpose of the Study:
- To implement and evaluate the effectiveness of a best practice advisory (BPA) integrated with an Atrial Fibrillation Decision Support Tool (AFDST).
- To address the underutilization of anticoagulation therapy in AF patients within an electronic health record system.
- To improve appropriate thromboprophylaxis rates in ambulatory AF patients.
Main Methods:
- A prospective study enrolled 608 ambulatory AF patients receiving suboptimal anticoagulation.
- Patients were randomized to usual care with AFDST access or usual care plus a BPA notifying clinicians of potential therapy benefits.
- The primary outcome was the change to appropriate thromboprophylaxis at 3 months, assessed using the AFDST recommendations.
Main Results:
- The addition of a BPA to the AFDST significantly improved anticoagulation therapy.
- Appropriate thromboprophylaxis increased from 5% in the usual care group to 11% in the BPA group (p=0.02).
- The odds ratio for achieving appropriate therapy with the BPA was 2.31 (95% CI, 1.17-4.87).
Conclusions:
- A BPA integrated into an AF decision support tool effectively improved anticoagulation management.
- This intervention demonstrated success in enhancing therapeutic practice within a primary care academic health system.
- The findings support the use of provider-facing decision support tools to close practice gaps in AF care.
Background:
Atrial fibrillation (AF) is the most common cardiac rhythm disorder and a risk factor for stroke. Randomized trials have demonstrated that anticoagulation can reduce strokes in AF patients. Yet, widespread underutilization of this therapy continues. To address this practice gap, we designed a study to implement and evaluate the effectiveness of a best practice advisory (BPA) for an Atrial Fibrillation Decision Support Tool (AFDST) embedded within our electronic health record.
Methods:
Our intervention is provider-facing, focused on decision support. Clinical setting is ambulatory patients being seen by primary care physicians. We prospectively enrolled 608 patients in our health system who are currently receiving less than optimal anticoagulation therapy as determined by the AFDST and randomized them to one of two arms - 1) usual care, in which the AFDST is available for use; or 2) addition of a BPA to the AFDST notifying clinicians that their patient stands to gain significant benefit from a change in current therapy. Primary outcome was effectiveness of the BPA measured by change to "appropriate thromboprophylaxis" based on the AFDST recommendation at 3 months post-enrollment. Secondary endpoints included Reach and Adoption from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, & Maintenance) framework for implementation studies.
Results:
Among 562 patients with a minimum follow-up of 3 months, addition of a BPA to the AFDST resulted in significant improvement in anticoagulation therapy, 5 % (12/248) versus 11 % (33/314) p = 0.02, odds ratio 2.31 (95 % CI, 1.17-4.87).
Conclusions:
A BPA added to an AF decision support tool improved anticoagulation therapy among AF patients in a primary care academic health system setting.
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