Evidence map›Paper›PMID 39978665›Full record

Trial reportAmerican heart journal2025

Impact of a clinical atrial fibrillation risk estimation tool on cardiac rhythm monitor utilization following acute ischemic stroke: A prepost clinical trial.

Jeffrey M Ashburner, Reinier W P Tack, Shaan Khurshid, Ashby C Turner, Steven J Atlas, Daniel E Singer, Patrick T Ellinor, Emelia J Benjamin, Ludovic Trinquart, Steven A Lubitz and 1 more

Registry-linked trialAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in American heart journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04637087 (Precision Medicine in Ischemic Stroke and Atrial Fibrillation), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
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.

NCT04637087 nacompletednot on this map

Precision Medicine in Ischemic Stroke and Atrial Fibrillation

TypeinterventionalSponsorMassachusetts General HospitalRan2021 to 2024Enrolled805ConditionsAtrial Fibrillation, Ischemic StrokeArmsAtrial fibrillation risk electronic health record alert
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. 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

11 authors.

Jeffrey M AshburnerDivision of General Internal Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA. Electronic address: jashburner@mgh.harvard.edu.
Reinier W P TackCardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA; McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA.
Shaan KhurshidCardiovascular Research Center, Massachusetts General Hospital, Boston, MA; Telemachus and Irene Demoulas Family Foundation Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA; Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA.
Ashby C TurnerDepartment of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Steven J AtlasDivision of General Internal Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA.
Daniel E SingerDivision of General Internal Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA.
Patrick T EllinorCardiovascular Research Center, Massachusetts General Hospital, Boston, MA; Telemachus and Irene Demoulas Family Foundation Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA.
Emelia J BenjaminBoston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA; Sections of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Department of Epidemiology, Boston University Chobanian and Avedisian School of Medicine, Boston University School of Public Heath, Boston, MA.
Ludovic TrinquartInstitute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Medford, MA.
Steven A LubitzCardiovascular Research Center, Massachusetts General Hospital, Boston, MA; Telemachus and Irene Demoulas Family Foundation Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA.
Christopher D AndersonCardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA; McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA.

Funding

IDENTIFICATION OF COMMON GENETIC VARIANTS FOR ATRIAL FIBRILLATION AND PR INTERVALR01HL092577 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI BENJAMIN, EMELIA J., ELLINOR, PATRICK THOMAS · 2009 to 2025
$20.6M
Using Electrocardiogram Genetics to Inform Arrhythmia RiskR01HL157635 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI ELLINOR, PATRICK THOMAS, MIRSHAHI, TOORAJ · 2022 to 2025
$2.9M
FHS-NEXT - Framingham Novel EXam using TechnologyR01HL141434 · NHLBI · BOSTON UNIVERSITY MEDICAL CAMPUS · PI BENJAMIN, EMELIA J., MCMANUS, DAVID D. · 2019 to 2022
$2.5M
Identifying primary care patients at increased risk of atrial fibrillation for screening interventionsK01HL148506 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI ASHBURNER, JEFFREY M · 2019 to 2023
$887k
Electrocardiogram-based deep learning and decision analysis to improve atrial fibrillation risk estimationK23HL169839 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI Shaan Khurshid · 2023 to 2026
$860k
American Heart Association-American Stroke Association 18SFRN34110082American Heart Association-American Stroke Association 18SFRN34150007American Heart Association-American Stroke Association 18SFRN34250007NHLBI NIH HHS K01 HL148506NHLBI NIH HHS K23 HL169839NHLBI NIH HHS R01 HL092577NHLBI NIH HHS R01 HL141434NHLBI NIH HHS R01 HL157635
6 · The paper itself

Abstract

backgroundDetection of undiagnosed atrial fibrillation (AF) after ischemic stroke through extended cardiac monitoring is important for preventing recurrent stroke. We evaluated whether a tool that displays clinically predicted AF risk to clinicians caring for stroke patients was associated with the use of extended cardiac monitoring.

methodsWe prospectively included hospitalized ischemic stroke patients without known AF in a preintervention (October 2018 - June 2019) and intervention period (March 11, 2021 - March 10, 2022). The intervention consisted of an electronic health record (EHR)-based best-practice advisory (BPA) alert which calculated and displayed 5-year risk of AF. We used a multivariable Fine and Gray model to test for an interaction between predicted AF risk and period (preintervention vs intervention) with regards to incidence of extended cardiac monitoring. We compared the incidence of extended cardiac monitoring within 6-months of discharge between periods, stratified by BPA completion.

resultsWe included 805 patients: 493 in the preintervention cohort and 312 in the intervention cohort. In the intervention cohort, the BPA was completed for 180 (58%) patients. The association between predicted clinical risk of AF and incidence of 6-month extended cardiac monitoring was not different by time period (interaction HR = 1.00 [95% Confidence Interval (CI) 0.98; 1.02]). The intervention period was associated with an increased cumulative incidence of cardiac monitoring (adjusted HR = 1.32 [95% CI 1.03-1.69]).

conclusionsAn embedded EHR tool displaying predicted AF risk in a poststroke setting had limited clinician engagement and predicted risk was not associated with the use of extended cardiac monitoring. CLINICAL

trial registrationNCT04637087.

Indexed as

Atrial FibrillationIschemic StrokeAgedElectrocardiography, AmbulatoryElectronic Health RecordsFemaleHumansIncidenceMaleMiddle AgedProspective StudiesRisk Assessment

Identifiers

PMID39978665
PMCPMC12360245

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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.