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Usefulness of clinical decision support system as tool of good clinical practice in patients at low risk of coronary artery disease. The ARTICA co-operative database.

Session Digital health analysis

Speaker Ervina Shirka

Congress : ESC Congress 2018

  • Topic : e-cardiology / digital health, public health, health economics, research methodology
  • Sub-topic : Digital Health, Other
  • Session type : Moderated Posters
  • FP Number : P280

Authors : M Mazzanti (London,GB), E Shirka (Tirana,AL), F Pugliese (London,GB), H Gjergo (Tirana,AL), A Goda (Tirana,AL), A Pottle (Harefield,GB), E Hasimi (Tirana,AL), SE Deane (London,GB), N Dent (London,GB), N Mackay (London,GB), R Underwood (London,GB)

M. Mazzanti1 , E. Shirka2 , F. Pugliese3 , H. Gjergo2 , A. Goda2 , A. Pottle4 , E. Hasimi2 , S.E. Deane5 , N. Dent5 , N. Mackay5 , R. Underwood6 , 1Royal Brompton Hospital - London - United Kingdom , 2University Hospital Center Mother Theresa, Cardiology - Tirana - Albania , 3Barts Health NHS Trust, Cardiac Imaging - London - United Kingdom , 4Harefield Hospital, Nurse Consultant - Harefield - United Kingdom , 5Harefield Hospital, Nurse in Cardiology - London - United Kingdom , 6Imperial College London, RBH Nuclear Medicine - London - United Kingdom ,

European Heart Journal ( 2018 ) 39 ( Supplement ), 41-42

Background: The use of decision support systems (DSS) at the point of care may enhance the appropriateness of clinical cardiology versus human physician standard care (STD) bringing evidence-based medicine at the point-of-care.

Purpose: To analyze DSS results vs standard care (STD) in the clinical workflow of patients (pts) at low, low-to-intermediate pre test likelihood (L-LI) of coronary artery disease (CAD).

Methods: 692 pts (403 males and 289 females, age 57±7 years) with L-LI of CAD were referred for stable chest pain evaluation over a 16 month period in three different hospitals. A browsing computerized automated DSS and a human cardiologist STD were applied during the same day visit. Pre-test likelihood of CAD was based on clinical score + coronary artery calcium score (CACS). Significant CAD (>50% coronary stenosis) criteria were applied in all pts by computerized tomography coronary angiography (CTCA).

Results: Distribution of population for DSS and STD is shown in the table. 498 (72%) pts were classified as “No further test (NFT)”, 110 (15.9%) “Exercise test (ET)/Functional Imaging (FI)”, 84 (12.1%) “CTA” and 0 “(ICA)” by DSS. Of note, 483 (97%) of DSS “NFT” showed no significant CAD vs 576 (99%) of STD “CTA” (p=0.3). 110 (15.9%) pts were assigned by DSS to “ET/FI” as the first approach vs 27 (3.9%) of STD (p=0.0001). The remaining 38 of STD “ET/FI” performed the test after CTCA. The diagnostic accuracy was 97.8% by DSS in the “NFT” group.

Conclusions: DSS is a sensitive tool for applying good clinical practice in pts with a L-LI pre-test likelihood of CAD. For the “NFT” group DSS was demonstrated to be highly accurate to exclude CAD. It could be a promising tool to substantially improve health care quality avoiding unnecessary tests and reducing costs.

Table 1
Clinical Score + CAC (n/%)
Low (480 / 48.9)Low-to-intermediate (212 / 21.5)
CDSS (n/%)
  NFT (498 / 72)377 / 78.5121 / 57.0
  ET/FI (110 / 15.9)42 / 8.768 / 32.0
  CTA (84 / 12.1)61 / 12.823 / 11.0
  ICA (0 / 0)0 / 00 / 0
STD (n/%)
  NFT (45 / 6.5)39 / 8.16 / 2.8
  ET/FI (65 / 9.4)31 / 6.434 / 16.1
  CTA (582 / 84.1)410 / 85.5172 / 81.1
  ICA (0 / 0)0 / 00 / 0

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