Evidence map›Paper›PMID 29223435›Full record

ArticleAmerican heart journal2017

Atrial fibrillation decision support tool: Population perspective.

Mark H Eckman, Alexandru Costea, Mehran Attari, Jitender Munjal, Ruth E Wise, Carol Knochelmann, Matthew L Flaherty, Pete Baker, Robert Ireton, Brett M Harnett and 4 more

Registry-linked trialOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in American heart journal, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04099485 (EHR-Embedded Decision Support to Prevent Stroke in Patients With AF), which is not on this map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.7field-weighted citation impact, top 26% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04099485 nacompletednot on this mapstarted 2020, after this paper: background citation

EHR-Embedded Decision Support to Prevent Stroke in Patients With AF

TypeinterventionalSponsorUniversity of CincinnatiRan2020 to 2023Enrolled608ConditionsAtrial FibrillationArmsElectronic Health Record Best Practice Advisory
3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 9 citations in OpenAlex.

  1. Observational
  2. Racial and sex differences in optimizing anticoagulation therapy for patients with atrial fibrillation.American heart journal plus : cardiology research and practice · 2022
    Article
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 1 institution in 1 country.

Mark H EckmanDivision of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, OH; Center for Health Informatics, University of Cincinnati, Cincinnati, OH. Electronic address: mark.eckman@uc.edu.
Alexandru CosteaDivision of Cardiology, University of Cincinnati, Cincinnati, OH.
Mehran AttariDivision of Cardiology, University of Cincinnati, Cincinnati, OH.
Jitender MunjalDivision of Cardiology, University of Cincinnati, Cincinnati, OH.
Ruth E WiseDivision of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, OH.
Carol KnochelmannDivision of Cardiology, University of Cincinnati, Cincinnati, OH.
Matthew L FlahertyDepartment of Neurology, University of Cincinnati, Cincinnati, OH.
Pete BakerCenter for Health Informatics, University of Cincinnati, Cincinnati, OH.
Robert IretonCenter for Health Informatics, University of Cincinnati, Cincinnati, OH.
Brett M HarnettCenter for Health Informatics, University of Cincinnati, Cincinnati, OH.
Anthony C LeonardDepartment of Family and Community Medicine, University of Cincinnati, Cincinnati, OH.
Dylan SteenDivision of Cardiology, University of Cincinnati, Cincinnati, OH.
Adam RoseDivision of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, OH.
John KuesDepartment of Family and Community Medicine, University of Cincinnati, Cincinnati, OH.
University of Cincinnati · US

Funding

Cincinnati Center for Clinical and Translational Sciences and TrainingUL1TR000077 · NCATS · UNIVERSITY OF CINCINNATI · PI HEUBI, JAMES E. · 2012 to 2014
$9.9M
NCATS NIH HHS UL1 TR000077
6 · The paper itself

Abstract

backgroundAppropriate thromboprophylaxis for patients with atrial fibrillation or atrial flutter (AF) remains a national challenge. The recent availability of direct oral anticoagulants (DOACs) with comparable efficacy and improved safety compared with warfarin alters the balance between risk factors for stroke and benefit of anticoagulation. Our objective was to examine the impact of DOACs as an alternative to warfarin on the net benefit of oral anticoagulant therapy (OAT) in a real-world population of AF patients.

methodsThis is a retrospective cohort study of patients with paroxysmal or persistent nonvalvular AF. We updated an Atrial Fibrillation Decision Support Tool (AFDST) to include DOACs as treatment options. The tool generates patient-specific recommendations based upon individual patient risk factor profiles for stroke and major bleeding using quality-adjusted life-years (QALYs) calculated for each treatment strategy by a decision analytic model. The setting included inpatient and ambulatory sites in an academic health center in the midwestern United States. The study involved 5,121 adults with nonvalvular AF seen for any ambulatory visit or inpatient hospitalization over the 1-year period (January through December 2016). Outcome measure was net clinical benefit in QALYs.

resultsWhen DOACs are a therapeutic option, the AFDST recommends OAT for 4,134 (81%) patients and no antithrombotic therapy or aspirin for 489 (9%). A strong recommendation for OAT could not be made in 498 (10%) patients. When warfarin is the only option, OAT is recommended for 3,228 (63%) patients and no antithrombotic therapy or aspirin for 973 (19%). A strong recommendation for OAT could not be made in 920 (18%) patients. In total, 1,508 QALYs could be gained if treatment were changed to that recommended by the AFDST.

conclusionsAvailability of DOACs increases the proportion of patients for whom oral anticoagulation therapy is recommended in a real-world cohort of AF patients and increased projected QALYs by more than 1,500 when all patients are receiving thromboprophylaxis as recommended by the AFDST compared with current treatment.

Indexed as

Decision Support TechniquesPopulation SurveillanceAdministration, OralAgedAged, 80 and overAnticoagulantsAtrial FibrillationFemaleFollow-Up StudiesHemorrhageHumansIncidenceMaleMiddle AgedOhioRetrospective StudiesAnticoagulants

Identifiers

PMID29223435
PMCPMC5726779
OpenAlexW2746483051

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.