eHealth tools to provide structured assistance for Atrial Fibrillation Screening, Management And guideline Recommended Therapy in metropolitan general practice: the AF-SMART study

Orchard, Jessica; Neubeck, Lis; Freedman, Ben; Li, Jialin; Webster, Ruth; Zwar, Nicholas; Gallagher, Robyn; Ferguson, Caleb; Lowres, Nicole

Abstract

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 software (EDS).
Methods and Results: An electronic screening prompt appeared whenever an eligible patient’s (age ≥65, no AF diagnosis) medical record was opened in participating general practices. General practitioners (GPs) and practice nurses offered screening using a smartphone electrocardiogram, with validated AF algorithm. A 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. 1,805/11,476 (16%) eligible patients who attended were screened (44% male, mean age 75.7 years). Screening identified 19 (1.1%) new cases of AF (mean age 79 years, mean CHA₂DS₂-VASc 3.7, 53% male). GPs (n=30) performed 70% of all screenings (range 1-448 patients/GP). The proportion of AF patients with CHA₂DS₂-VASc≥2 males or ≥3 females prescribed oral anticoagulants (OAC) was higher for those diagnosed during the study: 15/18, 83%, for screen-detected, and 39/46, 85%, for clinically-detected; compared to 71% (933/1306) of patients diagnosed before the study (p

Citation

Orchard, J., Neubeck, L., Freedman, B., Li, J., Webster, R., Zwar, N., Gallagher, R., Ferguson, C., & Lowres, N. (2019). 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 JAHA, 8(1), https://doi.org/10.1161/JAHA.118.010959

• Journal Article Type: Article
• Acceptance Date: Dec 1, 2018
• Online Publication Date: Dec 28, 2018
• Publication Date: Jan 8, 2019
• Deposit Date: Dec 3, 2018
• Publicly Available Date: Dec 3, 2018
• Journal: Journal of the American Heart Association
• Print ISSN: 2047-9980
• Publisher: American Heart Association
• Peer Reviewed: Peer Reviewed
• Volume: 8
• Issue: 1
• DOI: https://doi.org/10.1161/JAHA.118.010959
• Keywords: atrial fibrillation, stroke prevention, screening, general practices, eHealth
• Public URL: http://researchrepository.napier.ac.uk/Output/1410816
• Contract Date: Dec 3, 2018