eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline‐Recommended Therapy in Metropolitan General Practice: The AF‐SMART Study
Background This eHealth implementation study aimed to evaluate strategies to promote opportunistic atrial fibrillation (AF) screening using electronic screening prompts and improve treatment using electronic decision support (EDS) software. Methods and Results An electronic screening prompt appeared...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.010959 |
| _version_ | 1819175160974934016 |
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| author | Jessica Orchard Lis Neubeck Ben Freedman Jialin Li Ruth Webster Nicholas Zwar Robyn Gallagher Caleb Ferguson Nicole Lowres |
| author_facet | Jessica Orchard Lis Neubeck Ben Freedman Jialin Li Ruth Webster Nicholas Zwar Robyn Gallagher Caleb Ferguson Nicole Lowres |
| author_sort | Jessica Orchard |
| collection | DOAJ |
| description | Background This eHealth implementation study aimed to evaluate strategies to promote opportunistic atrial fibrillation (AF) screening using electronic screening prompts and improve treatment using electronic decision support (EDS) software. Methods and Results An electronic screening prompt appeared whenever an eligible patient's (aged ≥65 years, no AF diagnosis) medical record was opened in participating general practices. General practitioners and practice nurses offered screening using a smartphone ECG, with validated AF algorithm. Guideline‐based EDS was provided to assist treatment decisions. Deidentified data were collected from practices using a data extraction tool. General practices (n=8) across Sydney, Australia, screened for a median of 6 months. A total of 1805 of 11 476 (16%) eligible patients who attended were screened (44% men, mean age 75.7 years). Screening identified 19 (1.1%) new cases of AF (mean age, 79 years; mean CHA2DS2‐VASc, 3.7; 53% men). General practitioners (n=30) performed 70% of all screenings (range 1–448 patients per general practitioner). The proportion of patients with AF who had CHA2DS2‐VASc ≥2 for men or ≥3 for women prescribed oral anticoagulants was higher for those diagnosed during the study: 15 of 18 (83%) for screen‐detected and 39 of 46 (85%) for clinically detected, compared with 933 of 1306 (71%) patients diagnosed before the study (P<0.001). The EDS was accessed 111 times for patients with AF and for 4 of 19 screen‐detected patients. Conclusions The eHealth tools showed promise. Adherence to guideline‐based oral anticoagulant prescription was significantly higher in patients diagnosed during the study period, although the EDS was only used in a minority. While the proportion of eligible patients screened and EDS use was relatively low, further refinements may improve uptake in clinical practice. Clinical Trial Registration URL: www.anzctr.org.au. Unique identifier: ACTRN12616000850471. |
| first_indexed | 2024-12-22T20:50:28Z |
| format | Article |
| id | doaj.art-9595e00e66f54afab89dc4286ae1dd8d |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T20:50:28Z |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-9595e00e66f54afab89dc4286ae1dd8d2022-12-21T18:13:06ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-01-018110.1161/JAHA.118.010959eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline‐Recommended Therapy in Metropolitan General Practice: The AF‐SMART StudyJessica Orchard0Lis Neubeck1Ben Freedman2Jialin Li3Ruth Webster4Nicholas Zwar5Robyn Gallagher6Caleb Ferguson7Nicole Lowres8Faculty of Medicine & Health The University of Sydney AustraliaEdinburgh Napier University Edinburgh United KingdomHeart Research Institute Charles Perkins Centre The University of Sydney AustraliaHeart Research Institute Charles Perkins Centre The University of Sydney AustraliaThe George Institute for Global Health University of New South Wales Sydney AustraliaUniversity of New South Wales Sydney New South Wales AustraliaFaculty of Medicine & Health The University of Sydney AustraliaWestern Sydney Nursing & Midwifery Research Centre Western Sydney University Sydney AustraliaHeart Research Institute Charles Perkins Centre The University of Sydney AustraliaBackground This eHealth implementation study aimed to evaluate strategies to promote opportunistic atrial fibrillation (AF) screening using electronic screening prompts and improve treatment using electronic decision support (EDS) software. Methods and Results An electronic screening prompt appeared whenever an eligible patient's (aged ≥65 years, no AF diagnosis) medical record was opened in participating general practices. General practitioners and practice nurses offered screening using a smartphone ECG, with validated AF algorithm. Guideline‐based EDS was provided to assist treatment decisions. Deidentified data were collected from practices using a data extraction tool. General practices (n=8) across Sydney, Australia, screened for a median of 6 months. A total of 1805 of 11 476 (16%) eligible patients who attended were screened (44% men, mean age 75.7 years). Screening identified 19 (1.1%) new cases of AF (mean age, 79 years; mean CHA2DS2‐VASc, 3.7; 53% men). General practitioners (n=30) performed 70% of all screenings (range 1–448 patients per general practitioner). The proportion of patients with AF who had CHA2DS2‐VASc ≥2 for men or ≥3 for women prescribed oral anticoagulants was higher for those diagnosed during the study: 15 of 18 (83%) for screen‐detected and 39 of 46 (85%) for clinically detected, compared with 933 of 1306 (71%) patients diagnosed before the study (P<0.001). The EDS was accessed 111 times for patients with AF and for 4 of 19 screen‐detected patients. Conclusions The eHealth tools showed promise. Adherence to guideline‐based oral anticoagulant prescription was significantly higher in patients diagnosed during the study period, although the EDS was only used in a minority. While the proportion of eligible patients screened and EDS use was relatively low, further refinements may improve uptake in clinical practice. Clinical Trial Registration URL: www.anzctr.org.au. Unique identifier: ACTRN12616000850471.https://www.ahajournals.org/doi/10.1161/JAHA.118.010959atrial fibrillationeHealthgeneral practicesscreeningstroke prevention |
| spellingShingle | Jessica Orchard Lis Neubeck Ben Freedman Jialin Li Ruth Webster Nicholas Zwar Robyn Gallagher Caleb Ferguson Nicole Lowres eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline‐Recommended Therapy in Metropolitan General Practice: The AF‐SMART Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation eHealth general practices screening stroke prevention |
| title | eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline‐Recommended Therapy in Metropolitan General Practice: The AF‐SMART Study |
| title_full | eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline‐Recommended Therapy in Metropolitan General Practice: The AF‐SMART Study |
| title_fullStr | eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline‐Recommended Therapy in Metropolitan General Practice: The AF‐SMART Study |
| title_full_unstemmed | eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline‐Recommended Therapy in Metropolitan General Practice: The AF‐SMART Study |
| title_short | eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline‐Recommended Therapy in Metropolitan General Practice: The AF‐SMART Study |
| title_sort | ehealth tools to provide structured assistance for atrial fibrillation screening management and guideline recommended therapy in metropolitan general practice the af smart study |
| topic | atrial fibrillation eHealth general practices screening stroke prevention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.010959 |
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