Optimizing compliance with clinical guidelines using a clinical decision support system in patients with hypertension and atrial fibrillation in real-world practice: a cluster-randomized comparative study INTELLECT-2

Abstract

Aim . To evaluate the impact of a clinical decision support system (CDSS) in the management of patients with hypertension (HTN) and atrial fibrillation (AF) on compliance with clinical guidelines in real-world clinical practice. Material and methods. A cluster-randomized comparative study was conducted in 8 internal medicine departments in Samara. The departments were randomized into two following groups: one with the CDSS for prescribing anticoagulant, antiarrhythmic, and antihypertensive therapy (n=3; 2 inpatient and 1 outpatient department) and one without the CDSS — routine clinical practice (n=5; 3 inpatient and 2 outpatient departments). The study included patients with both hypertension and AF. The mean follow-up period was 11,5±5,7 months. R e sults . The study included 272 patients. Prescription rate of reduced doses of direct oral anticoagulants was significantly lower in the CDSS group as follows: apixaban 2,5 mg (0,8% vs 4,4%, p<0,001) and rivaroxaban 15 mg (4,2% vs 15%, p<0,001). In the CDSS group, amiodarone was prescribed significantly less frequently for rhythm control (3,6% vs 30%, p<0,001), and catheter ablation were performed more frequently (16% vs 5%, p=0,014). With the use of CDSS, the proportion of patients with cardiovascular events (CVEs) during the 12-month follow-up period decreased (4,2% vs 13,9%; when converted to 10 patient-years, 0,39 and 1,71, p<0,001). Conclusion . CDSS implementation demonstrated a significant improvement in physician compliance with clinical guidelines in terms of prescribing optimal anticoagulant and antiarrhythmic therapy. Patients were more frequently referred for catheter ablation of AF. CDSS is associated with a reduced incidence of CVEs in patients with hypertension and AF.

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