eHealth tools to provide structured assistance for atrial fibrillation screening, management, and guideline-recommended therapy in metropolitan general practice: The AF-SMART study

Jessica Orchard; Lis Neubeck; Ben Freedman; Jialin Li; Ruth Webster; Nicholas Zwar; Robyn Gallagher; Caleb Ferguson; Nicole Lowres

doi:10.1161/JAHA.118.010959

eHealth tools to provide structured assistance for atrial fibrillation screening, management, and guideline-recommended therapy in metropolitan general practice: The AF-SMART study

Jessica Orchard^*, Lis Neubeck, Ben Freedman, Jialin Li, Ruth Webster, Nicholas Zwar, Robyn Gallagher, Caleb Ferguson, Nicole Lowres

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

14 Citations (Scopus)

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Abstract

Background—This eHealth 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 ₂ DS ₂ -VASc, 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 ₂ DS ₂ -VASc ≥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 eHealth 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: ACTRN12616000850471.

Original language	English
Article number	e010959
Journal	Journal of the American Heart Association
Volume	8
Issue number	1
DOIs	https://doi.org/10.1161/JAHA.118.010959
Publication status	Published - 1 Jan 2019
Externally published	Yes

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Orchard, J., Neubeck, L., Freedman, B., Li, J., Webster, R., Zwar, N., Gallagher, R., Ferguson, C., & Lowres, N. (2019). eHealth tools to provide structured assistance for atrial fibrillation screening, management, and guideline-recommended therapy in metropolitan general practice: The AF-SMART study. Journal of the American Heart Association, 8(1), [e010959]. https://doi.org/10.1161/JAHA.118.010959

Orchard, Jessica ; Neubeck, Lis ; Freedman, Ben ; Li, Jialin ; Webster, Ruth ; Zwar, Nicholas ; Gallagher, Robyn ; Ferguson, Caleb ; Lowres, Nicole. / eHealth tools to provide structured assistance for atrial fibrillation screening, management, and guideline-recommended therapy in metropolitan general practice: The AF-SMART study. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 1.

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title = "eHealth tools to provide structured assistance for atrial fibrillation screening, management, and guideline-recommended therapy in metropolitan general practice: The AF-SMART study",

abstract = " Background—This eHealth 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{\textquoteright}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 2 DS 2 -VASc, 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 2 DS 2 -VASc ≥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 eHealth 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: ACTRN12616000850471. ",

author = "Jessica Orchard and Lis Neubeck and Ben Freedman and Jialin Li and Ruth Webster and Nicholas Zwar and Robyn Gallagher and Caleb Ferguson and Nicole Lowres",

year = "2019",

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Orchard, J, Neubeck, L, Freedman, B, Li, J, Webster, R, Zwar, N, Gallagher, R, Ferguson, C & Lowres, N 2019, 'eHealth tools to provide structured assistance for atrial fibrillation screening, management, and guideline-recommended therapy in metropolitan general practice: The AF-SMART study', Journal of the American Heart Association, vol. 8, no. 1, e010959. https://doi.org/10.1161/JAHA.118.010959

eHealth tools to provide structured assistance for atrial fibrillation screening, management, and guideline-recommended therapy in metropolitan general practice: The AF-SMART study. / Orchard, Jessica; Neubeck, Lis; Freedman, Ben; Li, Jialin; Webster, Ruth; Zwar, Nicholas; Gallagher, Robyn; Ferguson, Caleb; Lowres, Nicole.

In: Journal of the American Heart Association, Vol. 8, No. 1, e010959, 01.01.2019.

Research output: Contribution to journal › Article › Research › peer-review

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T1 - eHealth tools to provide structured assistance for atrial fibrillation screening, management, and guideline-recommended therapy in metropolitan general practice: The AF-SMART study

AU - Orchard, Jessica

AU - Neubeck, Lis

AU - Freedman, Ben

AU - Li, Jialin

AU - Webster, Ruth

AU - Zwar, Nicholas

AU - Gallagher, Robyn

AU - Ferguson, Caleb

AU - Lowres, Nicole

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N2 - Background—This eHealth 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 2 DS 2 -VASc, 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 2 DS 2 -VASc ≥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 eHealth 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: ACTRN12616000850471.

AB - Background—This eHealth 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 2 DS 2 -VASc, 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 2 DS 2 -VASc ≥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 eHealth 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: ACTRN12616000850471.

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