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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12.	石应康, 董力, 付博. 中国人心脏瓣膜置换术后低强度抗凝治疗3000例随访1年报告. 四川大学学报(医学版), 2016, 47(1): 90-92.
13.	董力, 石应康, 付博, 等. 中国人心脏瓣膜置换术后低强度抗凝治疗的系统评价及文献分析. 中华医学杂志, 2014, 94(34): 2673-2676.
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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. 中华医学会心血管病学分会中国老年学学会心脑血管病专业委员会. 华法林抗凝治疗的中国专家共识. 中华内科杂志, 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. 张永春, 李业涛, 谢贵华, 等. 抗凝自我管理手机APP软件的研制与应用. 护理研究, 2020, 34(10): 1844-1845.
6. 中华医学会, 主编. 临床技术操作规范心血管外科学分册. 北京: 人民军医出版社, 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, 刘晓曼, 等. 远程管理在华法林抗凝治疗中的应用概况. 中国医院药学杂志, 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. 梁诗琪, 刘雨薇, 贺育华, 等.患者智能监测及风险预警的研究进展.中国普外基础与临床杂志, 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. 石应康, 董力, 付博. 中国人心脏瓣膜置换术后低强度抗凝治疗3000例随访1年报告. 四川大学学报(医学版), 2016, 47(1): 90-92.
13. 董力, 石应康, 付博, 等. 中国人心脏瓣膜置换术后低强度抗凝治疗的系统评价及文献分析. 中华医学杂志, 2014, 94(34): 2673-2676.
14. 马俊珩, 葛卫红, 于锋. 心脏瓣膜置换术后华法林低强度抗凝的疗效观察. 吉林医学, 2012, 33(31): 6759-6760.
15. 董力, 石应康, 许建屏, 等. 中国心脏瓣膜术后多中心低强度抗凝治疗注册登记及随访研究. 中华医学杂志, 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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