Electronic Alert System for Improving Stroke Prevention Among Hospitalized Oral-Anticoagulation-Naïve Patients With Atrial Fibrillation: A Randomized Trial.
- Silbernagel G Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria Department of Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Switzerland.
- Spirk D Institute of Pharmacology, University of Bern, Switzerland.
- Hager A Department of Medical Informatics, Inselspital, University of Bern, Switzerland.
- Baumgartner I Department of Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Switzerland.
- Kucher N Department of Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Switzerland nils.kucher@insel.ch.
- 2016-07-25
Published in:
- Journal of the American Heart Association. - 2016
anticoagulants
arrhythmia
atrial fibrillation
electronic alert system
embolism
Aged
Aged, 80 and over
Anticoagulants
Atrial Fibrillation
Electronic Health Records
Embolism
Female
Guideline Adherence
Hospitalization
Humans
Male
Medical Order Entry Systems
Middle Aged
Practice Guidelines as Topic
Quality Improvement
Stroke
English
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.
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.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1161/JAHA.116.003776
- PMID 27451467
- Persistent URL
- https://folia.unifr.ch/global/documents/233356
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