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Design and Evaluation of Acafib-App, a Clinical Decision Support System for Anticoagulant Considerations in Patients With Atrial Fibrillation Publisher Pubmed



Ansari R1, 2 ; Rezayi S3 ; Safaei AA4 ; Mollazadeh R5 ; Rezaei E6 ; Mafinejad MK7 ; Namazi S1, 2 ; Mohammadi K1, 2
Authors
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Authors Affiliations
  1. 1. Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Health Information Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
  4. 4. Department of Medical Informatics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
  5. 5. Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Medical Education, Virtual University of Medical Sciences, Tehran, Iran
  7. 7. Department of Medical Education, Health Professions Education Research Center, Education Development Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Source: BMC Cardiovascular Disorders Published:2025


Abstract

Background: Patients with atrial fibrillation are at risk for various complications, including thromboembolic events. This study involves developing and evaluating a Clinical Decision Support System (CDSS) to select appropriate anticoagulant drug, considering comorbidities, laboratory data, and concurrent medications. The system is based on a streamlined interpretation of the most recent globally accepted clinical guidelines. Methods: Primarily a semi-structured interview regarding the challenges in the field of thromboprophylaxis for AF and clinical pharmacists and cardiologists’ needs in practice was conducted. Then the required data were extracted from the latest guidelines and confirmed by the expert panel. Using Microsoft Visio software each scenario and its corresponding rules were modeled. Dart programming language, the Flutter framework, and the Visual Studio editor were used to develop the application. Finally, the uMARS questionnaire was used to evaluate the application quality. Results: The selection of the anticoagulants was reported to be the most challenging domain by 78.6% of the participants in the interview. According to the designed algorithms, the application was developed using Asp.net with the Microsoft SQL Server database platform. This CDSS is called ACAFiB-APP, which stands for Anticoagulant in AF Application. The user goes through various calculators and obtains the required data, moreover, the user will choose one or more comorbidities/clinical scenarios. Finally, ACAFiB-APP will represent the proper anticoagulant options with dosing and related considerations. All of the sections in the uMARS questionnaire received acceptable scores. Conclusions: The CDSS will facilitate the informed selection of anticoagulants for complicated AF cases by considering the patient clinical scenario. Clinical trial number: Not applicable. © The Author(s) 2025.
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