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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.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Comprehensive ED AF management tool | Other | Managing atrial fibrillation (AF) patients in the emergency department (ED) is complex, often requiring many separate decisions: How to best reduce the heart rate? Should emergency physicians attempt cardioversion? If so, how? Does this patient need stroke prevention? The investigators' CDSS provides emergency physicians with a one-stop, evidence-based resource that addresses all aspects of ED AF management. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of patients who were hospitalized | Through emergency department visit, an average of 8 hours | |
| Number of patients who received sustained rate-reduction medications | Through emergency department visit, an average of 8 hours | |
| Number of patients who received stroke prevention interventions | Through emergency department visit, an average of 8 hours |
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Inclusion Criteria:
Exclusion Criteria:
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Adult patients presenting to KPNC emergency departments with eligibility criteria
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Kaiser Permanente Antioch Emergency Department | Antioch | California | 94531 | United States | ||
| Kaiser Permanente Fremont Emergency Department |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39504024 | Derived | Vinson DR, Warton EM, Durant EJ, Mark DG, Ballard DW, Hofmann ER, Sax DR, Kene MV, Lin JS, Poth LS, Ghiya MS, Ganapathy A, Whiteley PM, Bouvet SC, Rauchwerger AS, Zhang JY, Shan J, DiLena DD, Kea B, Pai AP, Loyles JB, Solomon MD, Go AS, Reed ME. Decision Support Intervention and Anticoagulation for Emergency Department Atrial Fibrillation: The O'CAFE Stepped-Wedge Cluster Randomized Clinical Trial. JAMA Netw Open. 2024 Nov 4;7(11):e2443097. doi: 10.1001/jamanetworkopen.2024.43097. | |
| 37004068 |
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| Fremont |
| California |
| 94538 |
| United States |
| Kaiser Permanente Manteca Medical Center | Manteca | California | 95337 | United States |
| Kaiser Permanente Modesto Medical Center | Modesto | California | 95356 | United States |
| Kaiser Permanente Oakland Emergency Department | Oakland | California | 94611 | United States |
| Kaiser Permanente Richmond Emergency Department | Richmond | California | 94801 | United States |
| Kaiser Permanente Roseville Emergency Department | Roseville | California | 95661 | United States |
| Kaiser Permanente South Sacramento Emergency Department | Sacramento | California | 95823 | United States |
| Kaiser Permanente Sacramento Emergency Department | Sacramento | California | 95825 | United States |
| Kaiser Permanente San Francisco Emergency Department | San Francisco | California | 94115 | United States |
| Kaiser Permanente San Jose Emergency Department | San Jose | California | 95119 | United States |
| Kaiser Permanente San Leandro Emergency Department | San Leandro | California | 94577 | United States |
| Kaiser Permanente San Rafael Emergency Department | San Rafael | California | 94903 | United States |
| Kaiser Permanente Santa Clara Emergency Department | Santa Clara | California | 95051 | United States |
| Kaiser Permanente South San Francisco Emergency Department | South San Francisco | California | 94080 | United States |
| Kaiser Permanente Walnut Creek Medical Center | Walnut Creek | California | 94596 | United States |
| Derived |
| Vinson DR, Rauchwerger AS, Karadi CA, Shan J, Warton EM, Zhang JY, Ballard DW, Mark DG, Hofmann ER, Cotton DM, Durant EJ, Lin JS, Sax DR, Poth LS, Gamboa SH, Ghiya MS, Kene MV, Ganapathy A, Whiteley PM, Bouvet SC, Babakhanian L, Kwok EW, Solomon MD, Go AS, Reed ME; Kaiser Permanente CREST Network. Clinical decision support to Optimize Care of patients with Atrial Fibrillation or flutter in the Emergency department: protocol of a stepped-wedge cluster randomized pragmatic trial (O'CAFE trial). Trials. 2023 Mar 31;24(1):246. doi: 10.1186/s13063-023-07230-2. |
| ID | Term |
|---|---|
| D001281 | Atrial Fibrillation |
| ID | Term |
|---|---|
| D001145 | Arrhythmias, Cardiac |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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