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

Silbernagel, Günther; Spirk, David; Hager, Adrian; Baumgartner, Iris; Kucher, Nils (2016). Electronic Alert System for Improving Stroke Prevention Among Hospitalized Oral-Anticoagulation-Naïve Patients With Atrial Fibrillation: A Randomized Trial. Journal of the American Heart Association, 5(7), pp. 1-7. American Heart Association 10.1161/JAHA.116.003776

[img]
Preview
Text
Electronic alert system.pdf - Published Version
Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND).

Download (591kB) | Preview

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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Pharmacology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology

UniBE Contributor:

Silbernagel, Günther; Spirk, David; Baumgartner, Iris and Kucher, Nils

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2047-9980

Publisher:

American Heart Association

Language:

English

Submitter:

Catherine Gut

Date Deposited:

22 Mar 2017 11:20

Last Modified:

15 Sep 2017 00:30

Publisher DOI:

10.1161/JAHA.116.003776

PubMed ID:

27451467

Uncontrolled Keywords:

anticoagulants; arrhythmia; atrial fibrillation; electronic alert system; embolism

BORIS DOI:

10.7892/boris.93050

URI:

https://boris.unibe.ch/id/eprint/93050

Actions (login required)

Edit item Edit item
Provide Feedback