scholarly journals A Simple and Portable Algorithm for Identifying Atrial Fibrillation in the Electronic Medical Record

2016 ◽  
Vol 117 (2) ◽  
pp. 221-225 ◽  
Author(s):  
Shaan Khurshid ◽  
John Keaney ◽  
Patrick T. Ellinor ◽  
Steven A. Lubitz
Keyword(s):  
Atrial Fibrillation ◽  
Medical Record ◽  
Electronic Medical Record

scholarly journals Discrepancies in automated, electronic medical record-based CHA2DS2-VASc scores and clinician assessment for atrial fibrillation patients

2020 ◽  
Author(s):  
Aubrey E. Jones ◽  
Zameer Abedin ◽  
Olesya Ilkun ◽  
Rebeka Mukherjee ◽  
Mingyuan Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Treatment Group ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Language Processing ◽  
Significant Proportion ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Full Cohort ◽  
Ventricular Ejection Fraction

AbstractBackgroundClinical decision support tools for atrial fibrillation (AF) should include CHA2DS2- VASc scores to guide oral anticoagulant (OAC) treatment.ObjectiveWe compared automated, electronic medical record (EMR) generated CHA2DS2- VASc scores to clinician-documented scores, and report the resulting proportions of patients in the OAC treatment group.MethodsPatients were included if they had both a clinician documented and EMR-generated CHA2DS2-VASc score on the same day. EMR scores were based on billing codes, left ventricular ejection fraction from echocardiograms, and demographics; documented scores were identified using natural language processing. Patients were deemed “re-classified” if the EMR score was ≥2 but the documented score was <2, and vice versa. For the overall cohort and subgroups (sex and age group), we compared mean scores using paired t-tests and re-classification rates using chi-squared tests.ResultsAmong 5,767 patients, the mean scores were higher using EMR compared to documented scores (4.05 [SD 2.1] versus 3.13 [SD 1.8]; p<0.01) for the full cohort, and all subgroups (p<0.01 for all comparisons). If EMR scores were used to determine OAC treatment instead of documented scores, 8.3% (n=479, p<0.01) of patients would be re-classified, with 7.2% moving into and 1.1% moving out of the treatment group. Among 2,322 women, 4.7% (n=109, p<0.01) would be re-classified, with 4.1% into and 0.7% out of the treatment group. Among 3,445 men, 10.7% (n=370, p<0.01) would be re-classified, with 9.2% into and 1.5% out of the treatment group. Among 2,060 patients <65 years old, 18.1% (n=372, p<0.01) would be re-classified, with 15.8% into and 2.3% out of the treatment group. Among 1,877 patients 65-74 years old, 5.4% (n=101, p<0.01) would be re-classified, with 4.4% into and 1.0% out of the treatment group. Among 1,830 patients ≥75 years old, <1% would move into to the treatment group and none would move out of the treatment group.ConclusionsEMR-based CHA2DS2-VASc scores were, on average, almost a full point higher than the clinician-documented scores. Using EMR scores in lieu of documented scores would result in a significant proportion of patients moving into the treatment group, with the highest re-classifications rates in men and patients <65 years old.

Abstract 21: Comparison of Methods to Identify Atrial Fibrillation Patients from the Electronic Medical Record

2019 ◽  
Vol 12 (Suppl_1) ◽  
Author(s):  
Rebeka Mukherjee ◽  
Aubrey E Jones ◽  
Ian Hackett ◽  
Donald M Llyod-Jones ◽  
Jennifer Springer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Comparison Of Methods

Abstract 14156: Automated Electronic Medical Record Mapping to Identify Acute Precipitants of Atrial Fibrillation and Oral Anticoagulation Use

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mayank Sardana ◽  
Qiming Shi ◽  
Connor Saleeba ◽  
Tenes Paul ◽  
Alok Kapoor ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Oral Anticoagulation ◽  
Performance Metrics ◽  
Newly Diagnosed ◽  
Single Institution ◽  
Automated Algorithm ◽  
Icd 10

Introduction: Atrial fibrillation (AF) that is associated with acute precipitants frequently recurs and is associated with long-term morbidity and mortality. Leveraging a large electronic medical record (EMR) database, we previously reported the performance of an automated EMR-based algorithm to identify the acute precipitants of newly detected-AF, but its validation in other databases has not been performed. Hypothesis: Modified EMR-based algorithm would accurately identify acute precipitants of AF and oral anticoagulation (OAC) use after AF diagnosis Methods: Among all records (inpatient/outpatient/ER) in a single-institution EMR (10/1/17 - 12/31/19), we first identified 4493 records documenting newly-diagnosed AF (ICD 10: I48). We then applied the modified EMR-based algorithm to identify 13 acute AF precipitants (within 30 days of AF diagnosis, Figure 1) and determine OAC use after an AF diagnosis. We manually adjudicated a random subset of identified records (892 of 4493) to derive performance metrics of the EMR algorithm. Results: Of 4493 records with newly-diagnosed AF, the algorithm identified ≥1 acute precipitant in 831 records and ≥2 precipitants in 206 records. The most common precipitants were respiratory failure (38%) and pneumonia (35%). Among patients with CHADS2Vasc ≥2, 44% with an acute precipitant were prescribed an OAC vs. 63% free from a precipitant after initial AF diagnosis. EMR algorithm accurately identified the precipitants and OAC use after AF diagnosis (PPV 89% for both, Figure 1). Conclusions: In this validation study, our novel EMR-based automated algorithm was highly accurate at identifying acute precipitants of AF and OAC use after AF diagnosis. We also observed differential rates of OAC use between those with and without an acute precipitant. Application of the algorithm to multi-institutional datasets could help map the gaps in care (e.g., OAC use) AF patients with acute precipitants often experience.

scholarly journals Impact of Different Electronic Cohort Definitions to Identify Patients With Atrial Fibrillation From the Electronic Medical Record

2020 ◽  
Vol 9 (5) ◽  
Author(s):  
Rashmee U. Shah ◽  
Rebeka Mukherjee ◽  
Yue Zhang ◽  
Aubrey E. Jones ◽  
Jennifer Springer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medical Record ◽  
Electronic Medical Record

scholarly journals Exercise‐Based Cardiac Rehabilitation and All‐Cause Mortality Among Patients With Atrial Fibrillation

2021 ◽  
Author(s):  
Benjamin J. R. Buckley ◽  
Stephanie L. Harrison ◽  
Elnara Fazio‐Eynullayeva ◽  
Paula Underhill ◽  
Deirdre A. Lane ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Propensity Score ◽  
Cardiac Rehabilitation ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Research Network ◽  
Lower Odds ◽  
All Cause Mortality ◽  
Long Term Impact

Background There is limited evidence of long‐term impact of exercise‐based cardiac rehabilitation (CR) on clinical end points for patients with atrial fibrillation (AF). We therefore compared 18‐month all‐cause mortality, hospitalization, stroke, and heart failure in patients with AF and an electronic medical record of exercise‐based CR to matched controls. Methods and Results This retrospective cohort study included patient data obtained on February 3, 2021 from a global federated health research network. Patients with AF undergoing exercise‐based CR were propensity‐score matched to patients with AF without exercise‐based CR by age, sex, race, comorbidities, cardiovascular procedures, and cardiovascular medication. We ascertained 18‐month incidence of all‐cause mortality, hospitalization, stroke, and heart failure. Of 1 366 422 patients with AF, 11 947 patients had an electronic medical record of exercise‐based CR within 6‐months of incident AF who were propensity‐score matched with 11 947 patients with AF without CR. Exercise‐based CR was associated with 68% lower odds of all‐cause mortality (odds ratio, 0.32; 95% CI, 0.29–0.35), 44% lower odds of rehospitalization (0.56; 95% CI, 0.53–0.59), and 16% lower odds of incident stroke (0.84; 95% CI, 0.72–0.99) compared with propensity‐score matched controls. No significant associations were shown for incident heart failure (0.93; 95% CI, 0.84–1.04). The beneficial association of exercise‐based CR on all‐cause mortality was independent of sex, older age, comorbidities, and AF subtype. Conclusions Exercise‐based CR among patients with incident AF was associated with lower odds of all‐cause mortality, rehospitalization, and incident stroke at 18‐month follow‐up, supporting the provision of exercise‐based CR for patients with AF.

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