Optimizing Stroke Prevention in Patients With Atrial Fibrillation: A Cluster-Randomized Controlled Trial of a Computerized Antithrombotic Risk Assessment Tool in Australian General Practice, 2012–2013
ORIGINAL RESEARCH — Volume 13 — June 23, 2016
General practitioners recruited from 4 regions of general practice in New South Wales, Australia, and then randomly allocated: 25 general practitioners assigned to intervention (CARAT), and 25 general practitioners assigned to the control arm (usual care). Each general practitioner recruits 5 to 10 eligible patients (aged 65 years or older, diagnosis of atrial fibrillation). Up to 250 patients recruited into each arm. Baseline data (demographics, medical history, risk factors) on all patients collected by general practitioners and project officers. General practitioners in intervention arm apply CARAT, which recommends antithrombotic therapy; general practitioners make final decision on therapy. In control arm, project officer documents therapy prescribed by general practitioner. The following information is reported elsewhere: Follow-up data collected by project officer on all patients at 1 month, 6 months, and 12 months via telephone interview, verification by general practitioner, hospital medical records. In intervention arm, at 12 months, general practitioner applies CARAT again to review therapy in recruited patients; feedback from general practitioner collected through survey and interview. In control arm, general practitioners are interviewed on challenges in prescribing.
Figure 1. Schematic outline of a cluster-randomized controlled trial of a computerized antithrombotic risk assessment tool (CARAT) in a sample of general practices in New South Wales, Australia, 2012.
Figure 2. Changes in the use of antithrombotic therapy, by type of therapy and by patient groups (intervention arm and control arm), in a cluster-randomized controlled trial of a computerized antithrombotic risk assessment tool in a sample of general practices in New South Wales, Australia, 2012–2013. Percentages may not total 100 because of rounding.
|Therapy||Number of Patients (Proportion of Patients by Intervention Group and Control Group)|
|Intervention Group: Baseline Therapy||Intervention Group: Post-CARAT Therapy||Intervention Group: CARAT-Recommended Therapy||Control Group|
|Warfarin (± antiplatelet)||154 (74.8)||156 (75.7)||168 (81.6)||162 (86.6)|
|Aspirin only||17 (8.3)||14 (6.8)||38 (18.4)||6 (3.2)|
|Clopidogrel only||3 (1.5)||0 (0.0)||0 (0.0)||0 (0.0)|
|Dabigatran (± clopidogrel)||30 (14.6)||34 (16.5)||0 (0.0)||15 (8.0)|
|None||2 (1.0)||2 (1.0)||0 (0.0)||4 (2.1)|
|Total||206 (100.2)||206 (100.0)||206 (100.0)||187 (99.9)|
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