Abstract Body: Introduction:
Detection of undiagnosed atrial fibrillation (AF) after ischemic stroke through extended cardiac monitoring is important for preventing recurrent stroke. We performed a clinical trial testing whether offering clinically predicted AF risk to clinicians caring for patients hospitalized for stroke would influence the decision to perform extended cardiac monitoring.
Methods
We prospectively included ischemic stroke patients without known AF at our hospital in a pre-intervention (October 2018 – June 2019) and intervention period (March 11, 2021 – March 10, 2022). The intervention consisted of deployment of an electronic health record (EHR)-based best-practice alert (BPA) which, after completion by the clinician, calculated and displayed a 5-year risk of developing AF using the ReCHARGE-AF score which is a validated stroke population recalibration of the population-based CHARGE-AF score. ReCHARGE-AF scores for the pre-intervention period were calculated through chart review by the study team. We used a multivariable Fine and Gray model to test for an interaction between predicted AF risk and period (pre-intervention vs. intervention) with regards to incidence of extended cardiac monitoring. We compared the incidence of extended cardiac monitoring in the first 6 months after discharge between the pre-intervention and intervention period, stratified by whether the BPA was completed or not.
Results
We included 805 patients: 493 patients in the pre-intervention cohort and 312 in the intervention cohort. In the intervention cohort, the BPA was completed for 180 (58%) of patients. The association between predicted clinical risk of AF and incidence of 6-month extended cardiac monitoring was not different in the pre-intervention and intervention time periods for (interaction HR = 1.00 [95% Confidence Interval (CI) 0.98; 1.02]). Implementation of the BPA was associated with an increased cumulative incidence of cardiac monitoring (adjusted HR = 1.32 [95% CI 1.03-1.69]).
Conclusions
An embedded EHR tool displaying AF risk estimates in the post-stroke setting had limited clinican engagement and did not influence the decision to perform extended cardiac monitoring compared to a pre-intervention period.