Study objective was to improve decision-making and thromboprophylaxis for AF patients in our
system's primary care network by developing and implementing a computerized decision support
tool for individual patient-level decision-making about oral anticoagulant therapy. To
accomplish these goals, we studied the impact of a combination of education related to
anticoagulation therapy and adding a quality-improvement (QI) intervention to an educational
package (for practice staff and clinicians) using a computerized aid, the Atrial
Fibrillation Decision Support Tool (AFDST) for individual patient-level decision-making
about oral anticoagulant therapy in patients with non-valvular AF. The QI tool incorporates
individual patients' risk factor profiles for ischemic stroke and bleeding and provides a
recommendation for treatment based upon the projected quality-adjusted life expectancy
gained or lost with the addition of either oral anticoagulant therapy or aspirin compared
with no thromboprophylaxis.
Setting - Cluster randomized trial. Setting - Primary care practices of an integrated
healthcare system. Participants - 1,493 adults with non-valvular AF seen between April 2014
and March 2015.
Intervention - Treatment recommendations were made by an Atrial Fibrillation Decision
Support Tool (AFDST) based on projections for quality-adjusted life expectancy calculated by
a decision analytic model that integrates patient-specific risk factors for stroke and
- Study subjects were physicians in our primary care network.
- Patients included in the study were identified through our health system's clinical
data store with an International Classification of Diseases, Ninth Revision, Clinical
Modification (ICD-9-CM), diagnosis of atrial fibrillation (427.31) or atrial flutter
(427.32) who did not have diagnoses of mitral valve disease (394.x), aortic valve
disease (395.x), heart valve transplant (V42.2) or heart valve replacement (V42.3).