Electronic Alert System for Improving Stroke Prevention Among Hospitalized Oral-Anticoagulation-Naïve Patients With Atrial Fibrillation: A Randomized Trial

Günther Silbernagel, David Spirk, Adrian Hager, Iris Baumgartner, Nils Kucher, Günther Silbernagel, David Spirk, Adrian Hager, Iris Baumgartner, Nils Kucher

Abstract

Background: Many patients with atrial fibrillation (AF) do not receive oral anticoagulants (OAC) for the prevention of stroke and systemic embolism. We aimed to improve the prescription of (OAC) among hospitalized patients with AF.

Methods and results: We developed a computer-based electronic alert system for identifying hospitalized OAC-naïve patients with AF. The alert system contained a CHA2DS2-VASc score calculation tool and provided recommendations for OAC prescription. The alert system was tested in a 1:1 randomized controlled trial at the University Hospital Bern: Patients with suspected AF without an active prescription order were allocated to an alert group in which an alert was issued in the electronic patient chart and order entry system or to a control group in which no alert was issued. The primary end point was the rate of adequate OAC prescription at hospital discharge, defined as prescription in OAC-naïve men and women with CHA2DS2-VASc score ≥1 and ≥2, respectively. Overall, 889 OAC-naïve patients (455 from the alert group and 434 from the control group) were eligible for analysis. Although the CHA2DS2-VASc score module was used in only 48 (10.5%) patients from the alert group, 100 (22.0%) patients from the alert group versus 69 (15.9%) from the control group received adequate OAC prescription (relative risk 1.38; P=0.021). OAC or antiplatelet therapy was prescribed in 325 (71.4%) patients from the alert group versus 271 (62.4%) from the control group (P=0.004).

Conclusions: Versus standard care, the alert system modestly improved OAC prescription among consecutive hospitalized AF patients.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02455102.

Keywords: anticoagulants; arrhythmia; atrial fibrillation; electronic alert system; embolism.

© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1
Figure 1
Electronic alert screen that is sent to physicians in charge of patients with atrial fibrillation but without oral anticoagulation treatment.
Figure 2
Figure 2
Flow chart of the patients whose physicians in charge received electronic alerts reminding them about patients with atrial fibrillation without ongoing oral anticoagulant treatment. AF indicates atrial fibrillation; OAC, oral anticoagulation therapy.

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