Résumé
Background: Clinical decision support (CDS) tools designed to digest, filter, organize, and present health data are becoming essential in providing clinical and cost-effective care. Many are not rigorously evaluated for benefit before implementation. We assessed whether computerized CDS for primary care providers would improve atrial fibrillation (AF) management and outcomes as compared to usual care. Methods: Overall, 203 primary care providers were recruited, randomized, and then cluster stratified by location (urban, rural) to usual care (n = 99) or CDS (n = 104). Providers recruited 1,145 adult patients with AF to participate. The intervention was access to an evidenced-based, point-of-care computerized CDS designed to support guideline-based AF management. The primary efficacy outcome was a composite of unplanned cardiovascular hospitalizations and AF-related emergency department visits; the primary safety outcome was major bleeding, both over 1 year. Patients were the units of intention-to-treat analysis. Results: No significant effects on the primary efficacy (130 control, 118 CDS, hazard ratio: 0.98 [95% CI 0.71-1.37], P = .926) or safety (n = 7 usual care, n = 8 CDS, 1.3% total, P = .939) outcomes were observed at 12-months. Conclusions: IMPACT-AF rigorously assessed a CDS tool in a highly representative sample of primary care providers and their patients; however, no impact on outcomes was observed. Considering the proliferating use of CDS applications, this study highlights the need for efficacy assessments prior to adoption and clinical implementation.
| Langue d'origine | English |
|---|---|
| Pages (de-à) | 35-46 |
| Nombre de pages | 12 |
| Journal | American Heart Journal |
| Volume | 224 |
| DOI | |
| Statut de publication | Published - juin 2020 |
Note bibliographique
Funding Information:Funding for IMPACT-AF was via an unrestricted educational grant from Bayer Inc, with company representation on the study's executive committee (A. C., S. H. C.) as active but nonvoting members. The authors are solely responsible for the design and conduct of this study. The academic researchers independently conducted the trial, and undertook the primary data analyses and the drafting and editing of the article and its final contents. The corresponding author had full access to all study data and had final responsibility for the decision to submit for publication. No extramural funding was used to support the creation of this article.The authors wish to acknowledge the participation and/or support of the primary care providers and their patients, the study office team, Dalhousie University Faculty of Computer Science, and all the other stakeholders who contributed in some way to the IMPACT-AF study, including the Nova Scotia Department of Health and Wellness for sharing of relevant provincial datasets. Special thanks to Susan Alexander for her analysis of CDS use. Funding provided as an unrestricted grant from Bayer Inc.
Publisher Copyright:
© 2020 The Authors
ASJC Scopus Subject Areas
- Cardiology and Cardiovascular Medicine