Anticoagulation prescription for preventing stroke in patients with atrial fibrillation (AF) got a boost with the use of a computerized decision support system, according to a recent study.
In this video interview, Gregory Piazza, MD, an associate physician at Brigham and Women’s Hospital and assistant professor at Harvard Medical School, talks with DocWire News about implications of the Alert-Based Computerized Decision Support to Increase Anticoagulation Prescription Prevents Stroke and Myocardial Infarction in High-Risk Hospitalized Patients With Atrial Fibrillation (AF-ALERT) study. Dr. Piazza presented the results of the study at the recent American Heart Association 2018 Scientific Sessions in Chicago.
Anticoagulation for the prevention of stroke in AF is under-prescribed. The authors aimed to determine if an alert-based computerized decision support (CDS) would increase anticoagulation prescription in hospitalized AF patients at elevated risk for stroke. The study included 457 high-risk patients (CHA2DS2-VASc score≥1) with AF or atrial flutter and not taking anticoagulant therapy for stroke prevention. Patients (n=457) were randomized (1:1) fashion to an alert-based CDS to increase anticoagulation for stroke prevention in high-risk hospitalized AF patients versus no such notification.
Results indicated that those in the alert group was more likely to be prescribed anticoagulation during the hospitalization (25.8% vs. 9.5%, P=0.0001), at discharge (23.8% vs. 12.9%, p=0.003), and at 90 days (27.7% vs. 17.1%, P=0.007) compared with the control group. The alert resulted in a 55% relative risk reduction in a composite outcome of death, myocardial infarction (MI), cerebrovascular event, and systemic embolic event at 90 days, and also MI at 90 days by 87% (1.2% vs. 8.6%, P=0.0002; adjusted OR, 0.13; 95% CI, 0.04-0.45). Cerebrovascular events or systemic embolism at 90 days were reduced by 88% (0% vs. 2.4%, P=0.02; adjusted OR, 0.12; 95% CI, 0.0-0.91).
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