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Improving guideline adherence in atrial fibrillation using an EHR based clinical decision support system.


- candidate number21184
- NTR NumberNTR5011
- ISRCTNISRCTN no longer applicable
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR21-dec-2014
- Secondary IDsExpertAF-EHR 
- Public TitleImproving guideline adherence in atrial fibrillation using an EHR based clinical decision support system.
- Scientific TitleA clinical decision support system for improving adherence to ESC guidelines for stroke and bleeding risk calculation and anti-coagulation medication prescription in atrial fibrillation patients in cardiology.
- ACRONYM
- hypothesisThe use of a decision support system will increase adherence to the ESC guideline for atrial fibrillation in terms of calculation of bleeding and stroke risk, and accurate anti-thrombotic treatment for stroke prevention.
- Healt Condition(s) or Problem(s) studiedAtrial Fibrillation, Prevention, Ischemic stroke, Bleeding, Anticoagulants
- Inclusion criteriaPatients: All patients with atrial fibrillation visiting the cardiologist of one of the three selected hospitals.

Cardiologists: All cardiologists working at one of the three selected hospitals in the Netherlands
- Exclusion criteriaN/A
- mec approval receivedyes
- multicenter trialyes
- randomisedyes
- masking/blindingNone
- controlActive
- groupParallel
- Type2 or more arms, randomized
- Studytypeintervention
- planned startdate 1-feb-2015
- planned closingdate1-aug-2015
- Target number of participants500
- InterventionsThe decision support system is implemented within the electronic health record (EHR) of a patient. When entering the diagnoses atrial fibrillation in the EHR of the patient, the system calculates the risk of stroke (CHA2DS2-VASc score) and the risk of bleeding (HAS-BLED score) based on the values entered/saved in the EHR. Furthermore, based on the calculated bleeding and stroke risk, a medication advice is given in terms of OAC/NOAC.

The intervention arm received the embedded decision support withing the EHR, whereas the control arm uses the EHR without the decision support system.
- Primary outcomeThe proportion of patients with atrial fibrillation whose anti-thrombotic treatment is in accordance with the ESC guideline for atrial fibrillation.
- Secondary outcomeN/A
- TimepointsData of each patient visiting the cardiologist for AF are saved automatically. Adherence is measured at the end of the study.
- Trial web siteN/A
- statusplanned
- CONTACT FOR PUBLIC QUERIES R.J. van Brummelen
- CONTACT for SCIENTIFIC QUERIES R.J. van Brummelen
- Sponsor/Initiator Academic Medical Center (AMC), Amsterdam
- Funding
(Source(s) of Monetary or Material Support)
Academic Medical Center (AMC)
- PublicationsN/A
- Brief summaryA decision support system will be implemented in the cardiologists EHR. This system will calculate the bleeding and stroke risk of patients (CHA2DS2-VASc score and HAS-BLED score), triggered by entering the diagnosis atrial fibrillation in the EHR. The system calculates the risk scores based on values already available in the EHR, and advices on antithrombotic treatment in terms of OAC/NOAC.

Our main outcomes will be the percentage of accurate anti thrombotic prescriptions in patients with atrial fibrillation according to the ESC guideline for atrial fibrillation.
- Main changes (audit trail)
- RECORD21-dec-2014 - 3-apr-2015


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