SMART-AF: Development of a decision support smartphone app to improve antithrombotic prescribing in atrial fibrillation

Abstract

Introduction: Appropriate thromboprophylaxis in patients with atrial fibrillationIntroduction. Appropriate thromboprophylaxis in patients with atrial fibrillation (AF) is highly effective in reducing the risk of stroke. Previous studies have demonstrated underuse of anticoagulants in high-risk patients, and while the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) may increase access to anticoagulation, these agents are associated with a new range of clinical problems necessitating improved prescriber support. Aims: To develop and validate a decision support smartphone application (‘app’) to support prescribers in the choice of thromboprophylaxis in patients with AF. Methods: The app was developed via collaboration between a haematologist, stroke physician, cardiologist, specialist clinical pharmacists, pharmacy academics and information technology experts to increase use of contemporary evidence-based guidelines and stroke and bleeding risk stratification tools, and address poor understanding of the clinical use of NOACs. The app provides assessment of patients’ stroke and bleeding risk using entered patient data, a recommendation for the need for anticoagulation, and suggestions and practice points regarding the most suitable antithrombotic agent(s). Validation was undertaken by comparing the app’s prescribing recommendations with the consensus opinion of an expert panel of clinicians for seven hypothetical case studies. Results: Initial testing identified the need to make minor amendments to the app logic and interface to ensure consistency with the experts’ recommendations. These were addressed in the final build, and the app is due for launch in late September 2015. Discussion: Multidisciplinary collaboration has resulted in the development of a validated, readily accessible decision support tool for prescribers initiating thromboprophylaxis in patients with AF. Initial prescriber feedback has been positive. Future research will investigate the usability of the app, and its effect on prescriber confidence and prescribing choices, with the aim of optimising the clinical outcomes for patients with AF. (AF) is highly effective in reducing the risk of stroke. Previous studies have demonstrated underuse of anticoagulants in high-risk patients, and while the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) may increase access to anticoagulation, these agents are associated with a new range of clinical problems necessitating improved prescriber support. Aims: To develop and validate a decision support smartphone application (‘app’) to support prescribers in the choice of thromboprophylaxis in patients with AF. Methods. The app was developed via collaboration between a haematologist, stroke physician, cardiologist, specialist clinical pharmacists, pharmacy academics and information technology experts to increase use of contemporary evidence-based guidelines and stroke and bleeding risk stratification tools, and address poor understanding of the clinical use of NOACs. The app provides assessment of patients’ stroke and bleeding risk using entered patient data, a recommendation for the need for anticoagulation, and suggestions and practice points regarding the most suitable antithrombotic agent(s). Validation was undertaken by comparing the app’s prescribing recommendations with the consensus opinion of an expert panel of clinicians for seven hypothetical case studies. Results: Initial testing identified the need to make minor amendments to the app logic and interface to ensure consistency with the experts’ recommendations. These were addressed in the final build, and the app is due for launch in late September 2015. Discussion: Multidisciplinary collaboration has resulted in the development of a validated, readily accessible decision support tool for prescribers initiating thromboprophylaxis in patients with AF. Initial prescriber feedback has been positive. Future research will investigate the usability of the app, and its effect on prescriber confidence and prescribing choices, with the aim of optimising the clinical outcomes for patients with AF.