title: Electronic Alert System for Improving Stroke Prevention Among Hospitalized Oral-Anticoagulation-Naïve Patients With Atrial Fibrillation: A Randomized Trial.
abstract: 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.
  
  
  
  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).
  
  
  
  Versus standard care, the alert system modestly improved OAC prescription among consecutive hospitalized AF patients.
  
  
  
  URL: https://www.clinicaltrials.gov. Unique identifier: NCT02455102.
authors.affiliation: Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria Department of Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Switzerland.
authors.forename: Günther
authors.initials: G
authors.lastname: Silbernagel
authors.affiliation: Institute of Pharmacology, University of Bern, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Spirk
authors.affiliation: Department of Medical Informatics, Inselspital, University of Bern, Switzerland.
authors.forename: Adrian
authors.initials: A
authors.lastname: Hager
authors.affiliation: Department of Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Switzerland.
authors.forename: Iris
authors.initials: I
authors.lastname: Baumgartner
authors.affiliation: Department of Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Switzerland nils.kucher@insel.ch.
authors.forename: Nils
authors.initials: N
authors.lastname: Kucher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D057286:Electronic Health Records; D004617:Embolism / Q000209:etiology / Q000517:prevention & control; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: anticoagulants; arrhythmia; atrial fibrillation; electronic alert system; embolism