Trial reportBMJ quality & safety2019
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
Trial report in BMJ quality & safety, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 5 of them syntheses that pooled 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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 5 syntheses or guidelines pooled it, 19 citations in OpenAlex.
- Digital patient safety interventions in primary care: a systematic review and meta-analysis.BMC medicine · 2026Pooled it
- The Use of Machine Learning for Analyzing Real-World Data in Disease Prediction and Management: Systematic Review.JMIR medical informatics · 2025Pooled it
- Availability of Evidence for Predictive Machine Learning Algorithms in Primary Care: A Systematic Review.JAMA network open · 2024Pooled it
- Clinical service organisation for adults with atrial fibrillation.The Cochrane database of systematic reviews · 2024Pooled it
- Role of Artificial Intelligence Applications in Real-Life Clinical Practice: Systematic Review.Journal of medical Internet research · 2021Pooled it
- [Therapeutic Response to 20 mg of Esomeprazole Twice Daily in Patients with Gastroesophageal Reflux Disease-related Non-cardiac Chest Pain: An Open-Label Randomized Pilot Study].The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi · 2020Trial
- Artificial intelligence in cardiovascular care: a systematic review and meta-analysis of randomised controlled trials.EClinicalMedicine · 2026Article
- Artificial intelligence in primary care: innovation at a crossroads.The Lancet. Primary care · 2026Review
- Anticoagulation Stewardship Efforts Via Indication Reviews at a Veterans Affairs Health Care System.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2025Article
- Randomised controlled trials evaluating artificial intelligence in clinical practice: a scoping review.The Lancet. Digital health · 2024Article
- Prescribing of anticoagulation for atrial fibrillation in primary care.Journal of thrombosis and thrombolysis · 2022Observational
- Translating Clinical Guidelines Into Care Delivery Innovation: The Importance of Rigorous Methods for Generating Evidence.Journal of the American Heart Association · 2022Article
- Research Trends in Artificial Intelligence Applications in Human Factors Health Care: Mapping Review.JMIR human factors · 2021Review
- Big Data and Atrial Fibrillation: Current Understanding and New Opportunities.Journal of cardiovascular translational research · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 1 institution in 1 country.
Funding
Abstract
backgroundClinical guidelines recommend anticoagulation for patients with atrial fibrillation (AF) at high risk of stroke; however, studies report 40% of this population is not anticoagulated.
objectiveTo evaluate a population health intervention to increase anticoagulation use in high-risk patients with AF.
methodsWe used machine learning algorithms to identify patients with AF from electronic health records at high risk of stroke (CHA
resultsOf 1727 algorithm-identified high-risk patients with AF in clinics at the time of randomisation to intervention, 432 (25%) lacked evidence of anticoagulant prescriptions in the prior year. After pharmacist review, only 17% (75 of 432) of algorithm-identified patients were considered potentially undertreated at the time their clinic was randomised to intervention. Over a third (155 of 432) were excluded because they had a single prior AF episode (transient or provoked by serious illness); 36 (8%) had documented refusal of anticoagulation, the remainder had other reasons for exclusion. The intervention did not increase new anticoagulant prescriptions (intervention: 4.1% vs usual care: 4.0%, p=0.86).
conclusionsAlgorithms to identify underuse of anticoagulation among patients with AF in healthcare databases may not capture clinical subtleties or patient preferences and may overestimate the extent of undertreatment. Changing clinician behaviour remains challenging.
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What OpenQuestion holds
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.