Evaluation of a patient self-management system for warfarin therapy assisted by artificial intelligence_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Yongchun ¹ , LI Hailin ² ,  LI Yetao ¹ , CHEN Xinbu ³ , LONG Juan ³

1. Department of Cardiovascular Surgery, Guizhou Provincial People’s Hospital, Guiyang, 550002, P.R.China;
2. Tele-medicine Centre, Guizhou Provincial People’s Hospital, Guiyang, 550002, P.R.China;
3. Department of Hepatobiliary Surgery, Guizhou Provincial People’s Hospital, Guiyang, 550002, P.R.China;

Corresponding?author：

LI Yetao, Email: taw77@163.com

Keywords：

Warfarin; self-management; mobile health; artificial intelligence; decision support system

DOI：

10.7507/1007-4848.202101008

Video：

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Objective To verify the reliability of Anticlot Assistant, a patient self-management system for warfarin therapy assisted by artificial intelligence.Methods It was a single-center, prospective cohort study. The eligible 34 participants were recruited consecutively between November 29, 2017 to September 27, 2018 and managed by warfarin therapy via Anticlot Assistant. The recommendations of Anticlot Assistant were examined and verified by the doctors to ensure the security. Medical records were exported from the the background management system. An univariate analysis compared the outcomes between accepted and overridden records and a logistic regression model was built to determine independent predictors of the outcomes. The research team analyzed 153 medical records, which were from 18 participants and were input by 19 doctors. There were 97 records with doctor accepting the suggestion and 56 records with doctor rejecting the suggestion .Results When the doctors accepted the recommendations, the percentage of the next-test international normalized ratio (INR) in the therapeutic range was higher (64.95% vs. 44.64%, RR=2.298, 95%CI 1.173 to 4.499, P=0.014). The logistic regression analysis revealed that accepting the recommendations was an independent predictor for the next-test INR being in the therapeutic range after controlling potentially confounding factors (OR=2.446, 95%CI 1.103 to 5.423, P=0.028).Conclusion The algorithm of Anticlot Assistant is reasonable and reliable.

Citation： ZHANG Yongchun, LI Hailin, LI Yetao, CHEN Xinbu, LONG Juan. Evaluation of a patient self-management system for warfarin therapy assisted by artificial intelligence. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(5): 504-509. doi: 10.7507/1007-4848.202101008 Copy

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1. Buckingham TA, Hatala R. Anticoagulants for atrial fibrillation: Why is the treatment rate so low? Clin Cardiol, 2002, 25(10): 447-454.
2. Hirsh J, Fuster V, Ansell J, et al. American Heart Association/American College of Cardiology Foundation guide to warfarin therapy. Circulation, 2003, 107(12): 1692-1711.
3. 中華醫學會心血管病學分會中國老年學學會心腦血管病專業委員會. 華法林抗凝治療的中國專家共識. 中華內科雜志, 2013, 52(1): 76-82.
4. Li Y, Dong L, Xiang D, et al. Patient compliance with an anticoagulation management system based on a smartphone application. J Thromb Thrombolysis, 2019, 48(2): 263-269.
5. 張永春, 李業濤, 謝貴華, 等. 抗凝自我管理手機APP軟件的研制與應用. 護理研究, 2020, 34(10): 1844-1845.
6. 中華醫學會, 主編. 臨床技術操作規范心血管外科學分冊. 北京: 人民軍醫出版社, 2009. 141-153.
7. Peduzzi P, Concato J, Kemper E, et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol, 1996, 49(12): 1373-1379.
8. 姜姝丹, 何秋毅, 劉曉曼, 等. 遠程管理在華法林抗凝治療中的應用概況. 中國醫院藥學雜志, 2020, 40(14): 1582-1586.
9. Holbrook A, Schulman S, Witt DM, et al. Evidence-based management of anticoagulant therapy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e152S-e184S.
10. 梁詩琪, 劉雨薇, 賀育華, 等.患者智能監測及風險預警的研究進展.中國普外基礎與臨床雜志, 2021. [Epub ahead of print].
11. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 129(23): 2440-2492.
12. 石應康, 董力, 付博. 中國人心臟瓣膜置換術后低強度抗凝治療3000例隨訪1年報告. 四川大學學報(醫學版), 2016, 47(1): 90-92.
13. 董力, 石應康, 付博, 等. 中國人心臟瓣膜置換術后低強度抗凝治療的系統評價及文獻分析. 中華醫學雜志, 2014, 94(34): 2673-2676.
14. 馬俊珩, 葛衛紅, 于鋒. 心臟瓣膜置換術后華法林低強度抗凝的療效觀察. 吉林醫學, 2012, 33(31): 6759-6760.
15. 董力, 石應康, 許建屏, 等. 中國心臟瓣膜術后多中心低強度抗凝治療注冊登記及隨訪研究. 中華醫學雜志, 2016, 96(19): 1489-1494.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Evaluation of a patient self-management system for warfarin therapy assisted by artificial intelligence

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