May 11, 2016 -- University of Cincinnati Academic Health Center -- Physician-researchers in the College of Medicine at the University of Cincinnati have developed a computerized decision support tool that uses a combination of patient information and characteristics to assist physicians and patients with decisions about blood thinning treatment to prevent strokes in individuals with atrial fibrillation.

They have used the decision support tool to review medical therapies for 1,876 patients in the primary care network at UC Health as part of a one-year cluster randomized clinical trial, explains Mark Eckman, MD, Posey Professor of Clinical Medicine. Half of the patients were cared for by physicians who were given access to the computerized model while a control group of patients had physicians who did not have access to the model.

Physicians were not required to use the computerized model, but among the subgroup of doctors who did, the number of patients who had medical therapies that differed from what was recommended by the model dropped from 63 percent to 59.1 percent. That change in prescribed medical therapies is considered clinically and statistically significant, says Eckman.
That advantage disappears when comparing the full cohort of patients whose doctors received access to the model and chose to use or not use it to those patients whose doctors were not given access and were part of the trial's control group. The findings were presented this week at the annual meeting of the Society of General Internal Medicine.

The computerized model is known as the Atrial Fibrillation Decision Support Tool. The Heart Rhythm Society has awarded a $250,000 grant to Eckman for his research related to the use of this tool. Funding of this grant will be provided by Boehringer-Ingelheim Corp.

"The tool is essentially a decision analytic model that we have integrated into our electronic health record and so it automatically pulls information about patients with atrial fibrillation and from that information is able to calculate for the individual patient their risk of AF-related stroke and major bleeding while taking blood thinning therapy," says Eckman, also Director of the UC Division of General Internal Medicine and a UC Health physician.

"There is a risk of major bleeding on blood thinning therapy and the tool basically delivers a recommendation based on the balance of risk and benefit indicating whether a patient on average would do better with blood thinning therapy versus without," says Eckman.

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