Habboushe Joseph, Altman Caroline, Lip Gregory Y H
MD Aware LLC (MDCalc.com), New York City, New York.
Department of Emergency Medicine, New York University/Bellevue Medical Center, New York City, New York.
Int J Clin Pract. 2019 Feb;73(2):e13280. doi: 10.1111/ijcp.13280. Epub 2018 Oct 30.
The impact of the utilisation of such e-health approaches, including mHealth (use of mobile phones and other wireless technology in the delivery of medical care) assessments of health parameters, or the use of decision aids and online risk calculators over time have not been previously described. The objective of this analysis is to assess the time trends in use of the CHADS and CHA DS VASc scores in e-health, and the geographical and specialty uptake of these scores, using data gleaned from a popular online clinical decision tool and medical reference, MDCalc. We hypothesised that the change in use of the scores would reflect the changes in guidelines and trends in clinical practice.
The CHA DS VASc score was the 20th most popular calculator in 2012, rising to the second most popular calculator in 2018; the CHADS score showed the converse, dropping from no. 3 to no. 22. Use of the CHA DS VASc scores particularly increased in the United States, Canada and Australia over time while the United Kingdom experienced a greater traffic share in 2015. The majority users of the CHADS and CHA DS VASc scores were primary care physicians, with cardiologists being in the minority; the proportion of cardiologists was greater outside USA, compared to within USA.
Over time, use of the CHA DS VASc score increased, while use of the CHADS score decreased. The change in uptake could partly be related to introduction of guidelines recommending the use of the CHA DS VASc score for stroke risk stratification.
此前尚未描述过此类电子健康方法的应用影响，包括移动健康（在医疗服务中使用手机和其他无线技术）对健康参数的评估，或随着时间推移使用决策辅助工具和在线风险计算器的情况。本分析的目的是利用从流行的在线临床决策工具和医学参考资料MDCalc收集的数据，评估电子健康中CHADS和CHADS - VASc评分的使用时间趋势，以及这些评分在地理区域和专业领域的应用情况。我们假设评分使用的变化将反映指南的变化和临床实践的趋势。
CHADS - VASc评分在2012年是第20最受欢迎的计算器，到2018年升至第二最受欢迎的计算器；CHADS评分则相反，从第3降至第22。随着时间的推移，CHADS - VASc评分在美国、加拿大和澳大利亚的使用尤其增加，而英国在2015年的流量份额更大。CHADS和CHADS - VASc评分的大多数用户是初级保健医生，心脏病专家占少数；与美国国内相比，美国以外地区心脏病专家的比例更高。
随着时间的推移，CHADS - VASc评分的使用增加，而CHADS评分的使用减少。使用情况的变化可能部分与推荐使用CHADS - VASc评分进行中风风险分层的指南出台有关。
