Impact of a clinical atrial fibrillation risk estimation tool on cardiac rhythm monitor utilization following acute ischemic stroke: A prepost clinical trial - 08/03/25
, Reinier W.P. Tack, MD e, f, g, h, 1, Shaan Khurshid, MD, MPH c, d, e, Ashby C. Turner, MD f, Steven J. Atlas, MD, MPH a, b, Daniel E. Singer, MD a, b, Patrick T. Ellinor, MD, PhD c, d, Emelia J. Benjamin, MD, ScM i, j, Ludovic Trinquart, PhD k, l, Steven A. Lubitz, MD, MPH c, d, 2, Christopher D. Anderson, MD, MMSc e, g, h, m, 2Highlights |
• | Clinician engagement with a best practice advisory alert that provided clinicians with clinically predicted risk of atrial fibrillation for stroke survivors was low. |
• | Providing clinicians with clinically predicted 5-year risk of atrial fibrillation was not associated with the use of extended cardiac monitoring among stroke survivors. |
• | The cumulative incidence of extended cardiac monitoring was higher in the intervention period compared to a preintervention period, but was not dependent on completion of the best practice advisory alert. |
Riassunto |
Background |
Detection 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.
Methods |
We 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.
Results |
We 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]).
Conclusions |
An 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 Registration |
NCT04637087
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| Jeffrey M. Ashburner and Reinier W.P. Tack contributed equally to the present study and share first authorship. |
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| Steven A. Lubitz and Christopher D. Anderson contributed equally to the present study and share senior authorship. |
Vol 284
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