实施基于电子健康记录的安全对比剂限制,预防经皮冠状动脉介入术后对比剂相关急性肾损伤。

IF 6.9 2区 医学
Neal Yuan, Justin Zhang, Rakan Khaki, Derek Leong, Chandrashekhar Bhoopalam, Steven W Tabak, Yaron Elad, Joshua M Pevnick, Susan Cheng, Joseph E Ebinger
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引用次数: 0

摘要

背景:经皮冠状动脉介入治疗后造影剂相关急性肾损伤(CA-AKI)与死亡率增加有关。我们评估了电子健康记录安全对比剂限制工具在预测 CA-AKI 风险、减少对比剂使用和 CA-AKI 方面的有效性:我们创建了一个警报,在经皮冠状动脉介入治疗前向心导管室工作人员显示安全对比度限制。该提示使用了从电子病历中自动提取的风险因素。我们纳入了 2020 年 6 月 1 日至 2021 年 10 月 1 日的手术;干预措施于 2021 年 2 月 10 日启用。通过差异分析,我们评估了与对照医院相比,实施造影剂限制工具后造影剂用量和 CA-AKI 发生率的变化。在实施警示前和实施 9 个月后,我们对心脏病专家进行了调查,内容包括信念、实践模式以及对例患者的安全对比度估计:结果:在一家干预医院,使用工具前和使用工具后分别进行了 508 例和 531 例经皮冠状动脉介入治疗。在 15 个对照地点,分别有 3550 例和 3979 例经皮冠状动脉介入治疗。对比度极限预测 CA-AKI 的准确率为 64.1%,阴性预测值为 93.3%,阳性预测值为 18.7%。使用该方法后,在高风险/可调风险患者(定义为计算出对比度极限结论)中,临床医生经常使用简化的评估方法来预测CA-AKI:临床医生经常使用一种简化的 CA-AKI 风险评估方法,这种方法不包括重要的风险因素,导致风险评估结果与已建立的模型不一致。尽管临床医生对此持怀疑态度,但基于电子病历的造影剂限制工具能更准确地预测 CA-AKI 风险,并能使经皮冠状动脉介入治疗过程中造影剂的使用量略有下降,但 CA-AKI 发生率没有变化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Implementation of an Electronic Health Records-Based Safe Contrast Limit for Preventing Contrast-Associated Acute Kidney Injury After Percutaneous Coronary Intervention.

Background: Contrast-associated acute kidney injury (CA-AKI) after percutaneous coronary intervention is associated with increased mortality. We assessed the effectiveness of an electronic health records safe contrast limit tool in predicting CA-AKI risk and reducing contrast use and CA-AKI.

Methods: We created an alert displaying the safe contrast limit to cardiac catheterization laboratory staff prior to percutaneous coronary intervention. The alert used risk factors automatically extracted from the electronic health records. We included procedures from June 1, 2020 to October 1, 2021; the intervention went live February 10, 2021. Using difference-in-differences analysis, we evaluated changes in contrast volume and CA-AKI rates after contrast limit tool implementation compared to control hospitals. Cardiologists were surveyed prior to and 9 months after alert implementation on beliefs, practice patterns, and safe contrast estimates for example patients.

Results: At the one intervention site, there were 508 percutaneous coronary interventions before and 531 after tool deployment. At 15 control sites, there were 3550 and 3979 percutaneous coronary interventions, respectively. The contrast limit predicted CA-AKI with an accuracy of 64.1%, negative predictive value of 93.3%, and positive predictive value of 18.7%. After implementation, in high/modifiable risk patients (defined as having a calculated contrast limit <500ml) there was a small but significant -4.60 mL/month (95% CI, -8.24 to -1.00) change in average contrast use but no change in CA-AKI rates (odds ratio, 0.96 [95% CI, 0.84-1.10]). Low-risk patients had no change in contrast use (-0.50 mL/month [95% CI, -7.49 to 6.49]) or CA-AKI (odds ratio, 1.24 [95% CI, 0.79-1.93]). In assessing CA-AKI risk, clinicians heavily weighted age and diabetes but often did not consider anemia, cardiogenic shock, and heart failure.

Conclusions: Clinicians often used a simplified assessment of CA-AKI risk that did not include important risk factors, leading to risk estimations inconsistent with established models. Despite clinician skepticism, an electronic health records-based contrast limit tool more accurately predicted CA-AKI risk and was associated with a small decrease in contrast use during percutaneous coronary intervention but no change in CA-AKI rates.

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来源期刊
Circulation. Cardiovascular Quality and Outcomes
Circulation. Cardiovascular Quality and Outcomes Medicine-Cardiology and Cardiovascular Medicine
CiteScore
9.80
自引率
2.90%
发文量
357
期刊介绍: Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.
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