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About the Authors:
Lars O. Karlsson
Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Writing - original draft, Writing - review & editing
* E-mail: [email protected]
Affiliation: Department of Cardiology, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
ORCID http://orcid.org/0000-0003-4852-3065
Staffan Nilsson
Roles Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Writing - review & editing
Affiliation: Primary Health Care Center in Vikbolandet, and Department of Medical and Health Sciences, Linköping University, Vikbolandet, Sweden
Magnus Bång
Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing - review & editing
Affiliation: Department of Computer and Information Science, Linköping University, Linköping, Sweden
ORCID http://orcid.org/0000-0003-3606-8579
Lennart Nilsson
Roles Conceptualization, Data curation, Investigation, Methodology, Writing - review & editing
Affiliation: Department of Cardiology, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
Emmanouil Charitakis
Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing - review & editing
Affiliation: Department of Cardiology, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
Magnus Janzon
Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Writing - review & editing
Affiliation: Department of Cardiology, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
ORCID http://orcid.org/0000-0002-9375-5087Abstract
Background
Atrial fibrillation (AF) is associated with substantial morbidity, in particular stroke. Despite good evidence for the reduction of stroke risk with anticoagulant therapy, there remains significant undertreatment. The main aim of the current study was to investigate whether a clinical decision support tool (CDS) for stroke prevention integrated in the electronic health record could improve adherence to guidelines for stroke prevention in patients with AF.
Methods and findings
We conducted a cluster-randomized trial where all 43 primary care clinics in the county of Östergötland, Sweden (population 444,347), were randomized to be part of the CDS intervention or to serve as controls. The CDS produced an alert for physicians responsible for patients with AF and at increased risk for thromboembolism (according to the CHA2DS2-VASc algorithm) without anticoagulant therapy. The primary endpoint was adherence to guidelines after 1 year. After randomization, there were 22 and 21 primary care clinics in the CDS and control groups, respectively. There were no significant differences in baseline adherence to guidelines regarding...