Development and validation of a Screening Tool to Evaluate and Warrant Anticoagulation Treatment prior to Discharge in inpatients with Atrial Fibrillation (STEWARxD-AF)

Charlotte Quintens; Lorenz Van der Linden; Kaat Meeusen; Egon Nijns; Rik Willems; Isabel Spriet

doi:10.1016/j.ijmedinf.2021.104555

Development and validation of a Screening Tool to Evaluate and Warrant Anticoagulation Treatment prior to Discharge in inpatients with Atrial Fibrillation (STEWAR_xD-AF)

Int J Med Inform. 2021 Oct:154:104555. doi: 10.1016/j.ijmedinf.2021.104555. Epub 2021 Aug 17.

Authors

Charlotte Quintens¹, Lorenz Van der Linden², Kaat Meeusen³, Egon Nijns⁴, Rik Willems⁵, Isabel Spriet⁶

Affiliations

¹ Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Pharmacy Department, University Hospitals Leuven, Leuven, Belgium. Electronic address: charlotte.quintens@uzleuven.be.
² Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Pharmacy Department, University Hospitals Leuven, Leuven, Belgium. Electronic address: lorenz.vanderlinden@uzleuven.be.
³ Department of Cardiology, University Hospitals Leuven, Leuven, Belgium. Electronic address: karolien.meeusen@uzleuven.be.
⁴ Department of Information Technology, University Hospitals Leuven, Leuven, Belgium. Electronic address: egon.nijns@uzleuven.be.
⁵ Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. Electronic address: rik.willems@uzleuven.be.
⁶ Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Pharmacy Department, University Hospitals Leuven, Leuven, Belgium. Electronic address: isabel.spriet@uzleuven.be.

PMID: 34438318
DOI: 10.1016/j.ijmedinf.2021.104555

Abstract

Objective: Anticoagulation is highly effective for stroke prevention in atrial fibrillation (AF), reducing the risk by about 64%. Despite overwhelming evidence in support of anticoagulation, up to 40% of AF patients remain untreated. We aimed to develop and validate STEWAR_xD-AF: a Screening Tool to Evaluate and Warrant Anticoagulation Treatment prior to Discharge in Atrial Fibrillation.

Materials and methods: STEWAR_xD-AF was developed by integrating information extracted from the electronic health record (EHR). A stepwise decision process was applied, based on AF diagnosis, estimated CHA₂DS₂-VASc-score and anticoagulant use. A priority score was assigned accordingly, ranging from 0 (no risk) to 5 (highest risk of undertreatment). A cross-sectional study was performed to assess the accuracy of STEWAR_xD-AF. Criterion and tool validity were ascertained by determining sensitivity and specificity, compared to a manual check of the EHR in an inpatient sample (n = 800). Consistency regarding the priority score was determined by estimating Cohen's kappa.

Results: A tool to screen for un(der)treated AF was developed and embedded into the EHR. Sensitivity and specificity for AF diagnosis were 98.4% and 87.6%, respectively. Overall sensitivity and specificity for identification of a CHA₂DS₂-VASc-score ≥ 2 was 97.7% and 72.7%. Sensitivity and specificity to determine the presence of anticoagulant treatment was at least 87.8% and 97.1% There was good agreement for the priority score (κ 0.74 (unweighted); 0.66 (weighted)).

Conclusions: STEWAR_xD-AF was able to identify untreated AF inpatients reliably and with a high sensitivity. Nearly no patients were missed. We will now implement this AF-screening tool in clinical practice to improve the use of anticoagulation and reduce the risk of stroke.

Keywords: Anticoagulant therapy; Atrial fibrillation; Clinical decision support; Screening tool; Stroke prevention.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anticoagulants / therapeutic use
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / drug therapy
Cross-Sectional Studies
Humans
Inpatients*
Patient Discharge
Risk Assessment

Substances

Anticoagulants