The Permanente Medical Group, Oakland, CA, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Trials. 2023 Mar 31;24(1):246. doi: 10.1186/s13063-023-07230-2.
Management of adults with atrial fibrillation (AF) or atrial flutter in the emergency department (ED) includes rate reduction, cardioversion, and stroke prevention. Different approaches to these components of care may lead to variation in frequency of hospitalization and stroke prevention actions, with significant implications for patient experience, cost of care, and risk of complications. Standardization using evidence-based recommendations could reduce variation in management, preventable hospitalizations, and stroke risk.
We describe the rationale for our ED-based AF treatment recommendations. We also describe the development of an electronic clinical decision support system (CDSS) to deliver these recommendations to emergency physicians at the point of care. We implemented the CDSS at three pilot sites to assess feasibility and solicit user feedback. We will evaluate the impact of the CDSS on hospitalization and stroke prevention actions using a stepped-wedge cluster randomized pragmatic clinical trial across 13 community EDs in Northern California.
We hypothesize that the CDSS intervention will reduce hospitalization of adults with isolated AF or atrial flutter presenting to the ED and increase anticoagulation prescription in eligible patients at the time of ED discharge and within 30 days. If our hypotheses are confirmed, the treatment protocol and CDSS could be recommended to other EDs to improve management of adults with AF or atrial flutter.
ClinicalTrials.gov NCT05009225 . Registered on 17 August 2021.
在急诊科（ED）管理成人心房颤动（AF）或心房扑动包括降低心率、电复律和预防中风。这些护理成分的不同方法可能导致住院频率和预防中风措施的差异，这对患者体验、护理成本和并发症风险有重大影响。使用基于证据的建议进行标准化可以减少管理上的差异、预防住院和中风风险。
我们描述了我们基于 ED 的 AF 治疗建议的基本原理。我们还描述了电子临床决策支持系统（CDSS）的开发，以便在护理点为急诊医师提供这些建议。我们在三个试点地点实施了 CDSS，以评估可行性并征求用户反馈。我们将使用加利福尼亚州北部 13 个社区 ED 的阶梯式楔形随机实用临床试验评估 CDSS 对住院和中风预防措施的影响。
我们假设 CDSS 干预措施将减少因孤立性 AF 或心房扑动而就诊于 ED 的成年人的住院率，并增加符合条件的患者在 ED 出院时和 30 天内的抗凝药物处方。如果我们的假设得到证实，治疗方案和 CDSS 可以推荐给其他 ED，以改善 AF 或心房扑动成人的管理。
ClinicalTrials.gov NCT05009225。注册于 2021 年 8 月 17 日。
