IMPACT-AF: Computerized Support System Doesn’t Improve Unplanned AF-related ED Visits

An online computerized decision support system had no effect on the number of patients experiencing an unplanned hospitalization for an atrial fibrillation (AF)-related emergency department (ED) visits, new study results presented at the American Heart Association 2018 Scientific Sessions suggested.

Researchers for this prospective study randomly assigned (1:1) individual primary care providers/group practices to either a clinical decision support system (n=597) or usual care (n=548). The composite study outcome of unplanned cardiovascular [CV] hospitalizations and AF-related ED visits over 1 year.

The results showed no differences between study groups at one year for AF-related ED visits or unplanned CV hospitalization (primary and secondary efficacy outcomes) and made no difference in stroke or all-cause mortality. All associations were statistically insignificant. There was a signal towards improved outcomes, but it did not reach statistical significance.

“IMPACT-AF was unable to show a significant effect on time to AF-related ER visit or unplanned CV hospitalizations for primary care physicians using a computer decision support system versus usual care,” Jafna L. Cox, MD, of Dalhousie University in Halifax, Nova Scotia, said in a concluding presentation slide. “Nonetheless, incident rate ratios suggest the potential for marked reductions in events with such tools, but more and better user training and longer duration of use will be required to confirm this.”

Some of the study limitations included inadequate user interface, too short of a study duration to see potential impact on clinical outcomes, and also the fact that computerized clinical support system interventions may not show up in clinical outcomes (although they may show up on process of care outcomes).

Dr. Cox added that “an important lesson of the study should be that any health care app or device, let alone a computerized decision support system, must be rigorously assessed and ideally (via randomized clinical trial.”

Read more DocWire News coverage of AHA 2018 here.