Clinical Decision Support for Atrial Fibrillation and Flutter

Status unconfirmed

Conditions studied: Atrial Fibrillation and Flutter

In brief

Atrial fibrillation (AF) is a major public health problem: it impairs quality of life and independently heightens the risks of ischemic stroke, heart failure and all-cause mortality. AF is a common reason for presenting to emergency departments (ED) in Kaiser Permanente Northern California (KPNC) and is associated with frequent hospitalization. Additionally, inter-facility hospitalization rates for AF vary across KPNC. Improvements in modifiable components of ED AF care could potentially reduce low-yield hospitalizations and the associated costs, patient inconveniences, and complications that can ensue. Real-time clinical decision support systems (CDSS) can transform entrenched physician practices and improve patient outcomes. The investigators will conduct a stepped-wedge cluster randomized trial of a CDSS intervention across 13 KPNC EDs for the comprehensive management of acute AF with the following three aims: 1) To evaluate the impact of the CDSS intervention on index hospitalization rates; 2) To evaluate the impact of the CDSS intervention on ED AF rate and rhythm control process-of-care metrics; and 3) To evaluate the impact of the CDSS intervention on AF stroke prevention actions for eligible participants at the time of ED discharge. The investigators hypothesize that the CDSS intervention will safely reduce index hospitalization rates, improve rate and rhythm control process-of-care metrics, and increase stroke prevention actions for eligible participants at ED discharge and within 30 days.

Key facts

Study ID

NCT05009225

Run by

Kaiser Permanente

People needed

4000

Starts

2021-10-01

Expected to finish

2024-06-30

Last updated by the study team

2024-03-06

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Adult (≥18y) KPNC members presenting to the ED with a primary ED diagnosis of atrial fibrillation/flutter (AF/FL). Subjects who meet criteria will be identified electronically within the CDSS tool in the electronic health record.

You may not qualify if…

• Children (<18y).
• Non-members of KPNC.
• Patients who were prisoners, pregnant, receiving hospice or palliative care, or who left against medical advice at the index encounter for AF/FL.

Where it is running

• Kaiser Permanente Antioch Emergency Department — Antioch, California, United States
• Kaiser Permanente Fremont Emergency Department — Fremont, California, United States
• Kaiser Permanente Manteca Medical Center — Manteca, California, United States
• Kaiser Permanente Modesto Medical Center — Modesto, California, United States
• Kaiser Permanente Oakland Emergency Department — Oakland, California, United States
• Kaiser Permanente Richmond Emergency Department — Richmond, California, United States
• Kaiser Permanente Roseville Emergency Department — Roseville, California, United States
• Kaiser Permanente South Sacramento Emergency Department — Sacramento, California, United States
• Kaiser Permanente Sacramento Emergency Department — Sacramento, California, United States
• Kaiser Permanente San Francisco Emergency Department — San Francisco, California, United States
• Kaiser Permanente San Jose Emergency Department — San Jose, California, United States
• Kaiser Permanente San Leandro Emergency Department — San Leandro, California, United States
• Kaiser Permanente San Rafael Emergency Department — San Rafael, California, United States
• Kaiser Permanente Santa Clara Emergency Department — Santa Clara, California, United States
• Kaiser Permanente South San Francisco Emergency Department — South San Francisco, California, United States
• Kaiser Permanente Walnut Creek Medical Center — Walnut Creek, California, United States

Full record on ClinicalTrials.gov

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