Document Detail


Application of a decision support tool for anticoagulation in patients with non-valvular atrial fibrillation.
MedLine Citation:
PMID:  18373138     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Atrial fibrillation affects more than two million Americans and results in a fivefold increased rate of embolic strokes. The efficacy of adjusted dose warfarin is well documented, yet many patients are not receiving treatment consistent with guidelines. The use of a patient-specific computerized decision support tool may aid in closing the knowledge gap regarding the best treatment for a patient.
METHODS: This retrospective, observational cohort analysis of 6,123 Ohio Medicaid patients used a patient-specific computerized decision support tool that automated the complex risk-benefit analysis for anticoagulation. Adverse outcomes included acute stroke, major gastrointestinal bleeding, and intracranial hemorrhage. Cox proportional hazards models were developed to compare the group of patients who received warfarin treatment with those who did not receive warfarin treatment, stratified by the decision support tool's recommendation.
RESULTS: Our decision support tool recommended warfarin for 3,008 patients (49%); however, only 9.9% received warfarin. In patients for whom anticoagulation was recommended by the decision support tool, there was a trend towards a decreased hazard for stroke with actual warfarin treatment (hazard ratio 0.90) without significant increase in gastrointestinal hemorrhage (0.87). In contrast, in patients for whom the tool recommended no anticoagulation, receipt of warfarin was associated with statistically significant increased hazard of gastrointestinal bleeding (1.54, p = 0.03).
CONCLUSIONS: We have shown that our atrial fibrillation decision support tool is a useful predictor of those at risk of major bleeding for whom anticoagulation may not necessarily be beneficial. It may aid in weighing the benefits versus risks of anticoagulation treatment.
Authors:
Mark L Wess; Daniel P Schauer; Joseph A Johnston; Charles J Moomaw; David E Brewer; E Francis Cook; Mark H Eckman
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Publication Detail:
Type:  Journal Article; Validation Studies    
Journal Detail:
Title:  Journal of general internal medicine     Volume:  23     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-31     Completed Date:  2008-05-12     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  411-7     Citation Subset:  IM    
Affiliation:
Division of General Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267-0535, USA. mark.wess@uc.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anticoagulants / adverse effects*
Atrial Fibrillation / drug therapy*
Cohort Studies
Decision Support Systems, Clinical*
Female
Humans
International Normalized Ratio
Male
Medicaid
Medical Audit*
Medical Order Entry Systems
Middle Aged
Ohio
Physician's Practice Patterns*
Proportional Hazards Models
Retrospective Studies
Stroke / prevention & control
United States
Warfarin / adverse effects*
Chemical
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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