1 Faculty of Medicine & Health The University of Sydney Australia.
2 Heart Research Institute Charles Perkins Centre The University of Sydney Australia.
J Am Heart Assoc. 2019 Jan 8;8(1):e010959. doi: 10.1161/JAHA.118.010959.
Background This eH ealth implementation study aimed to evaluate strategies to promote opportunistic atrial fibrillation ( AF ) screening using electronic screening prompts and improve treatment using electronic decision support ( EDS ) software. Methods and Results An electronic screening prompt appeared whenever an eligible patient's (aged ≥65 years, no AF diagnosis) medical record was opened in participating general practices. General practitioners and practice nurses offered screening using a smartphone ECG, with validated AF algorithm. Guideline-based EDS was provided to assist treatment decisions. Deidentified data were collected from practices using a data extraction tool. General practices (n=8) across Sydney, Australia, screened for a median of 6 months. A total of 1805 of 11 476 (16%) eligible patients who attended were screened (44% men, mean age 75.7 years). Screening identified 19 (1.1%) new cases of AF (mean age, 79 years; mean CHA DS - VAS c, 3.7; 53% men). General practitioners (n=30) performed 70% of all screenings (range 1-448 patients per general practitioner). The proportion of patients with AF who had CHA DS - VAS c ≥2 for men or ≥3 for women prescribed oral anticoagulants was higher for those diagnosed during the study: 15 of 18 (83%) for screen-detected and 39 of 46 (85%) for clinically detected, compared with 933 of 1306 (71%) patients diagnosed before the study ( P<0.001). The EDS was accessed 111 times for patients with AF and for 4 of 19 screen-detected patients. Conclusions The eH ealth tools showed promise. Adherence to guideline-based oral anticoagulant prescription was significantly higher in patients diagnosed during the study period, although the EDS was only used in a minority. While the proportion of eligible patients screened and EDS use was relatively low, further refinements may improve uptake in clinical practice. Clinical Trial Registration URL : www.anzctr.org.au . Unique identifier: ACTRN 12616000850471.
这项电子健康实施研究旨在评估利用电子筛查提示促进机会性心房颤动（AF）筛查的策略，并利用电子决策支持（EDS）软件改善治疗效果。
只要符合条件的患者（年龄≥65 岁，无 AF 诊断）的病历在参与的全科医生诊所中打开，就会出现电子筛查提示。全科医生和执业护士使用智能手机心电图进行筛查，采用经过验证的 AF 算法。基于指南的 EDS 用于辅助治疗决策。使用数据提取工具从实践中收集去识别数据。澳大利亚悉尼的 8 家全科医生诊所进行了中位数为 6 个月的筛查。在 11476 名符合条件的就诊患者中，共有 1805 名（44%为男性，平均年龄 75.7 岁）接受了筛查。筛查发现 19 例（1.1%）新的 AF 病例（平均年龄 79 岁；平均 CHA2DS2-VASc 为 3.7；53%为男性）。全科医生（n=30）进行了所有筛查的 70%（每位全科医生范围为 1-448 名患者）。在研究期间诊断的患者中，CHA2DS2-VASc 男性≥2 分或女性≥3 分的 AF 患者服用口服抗凝剂的比例更高：18 例（83%）筛查发现，46 例（85%）临床发现，而在研究前诊断的 1306 例患者中，933 例（71%）服用了口服抗凝剂（P<0.001）。EDS 为 111 例 AF 患者和 19 例筛查发现的患者中的 4 例患者提供了服务。
电子健康工具显示出前景。在研究期间诊断的患者中，基于指南的口服抗凝剂处方的依从性显著提高，尽管 EDS 仅在少数情况下使用。尽管筛查的合格患者比例和 EDS 的使用相对较低，但进一步的改进可能会提高临床实践中的使用率。
