AIMS Despite widely available risk stratification tools, safe and effective anticoagulant options, and guideline recommendations, anticoagulation for stroke prevention in atrial fibrillation (AF) is underprescribed. We created and evaluated an alert-based computerized decision support (CDS) strategy to increase anticoagulation prescription in hospitalized AF patients at high risk for stroke. METHODS AND RESULTS We enrolled 458 patients (CHA2DS2-VASc score ≥1) with AF who were not prescribed anticoagulant therapy and were hospitalized at Brigham and Women's Hospital. Patients were randomly allocated, according to Attending Physician of record, to intervention (alert-based CDS) vs. control (no notification). The primary efficacy outcome was the frequency of anticoagulant prescription. The CDS tool assigned 248 patients to the alert group and 210 to the control group. Patients in the alert group were 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). The alert reduced the odds of a composite outcome of death, myocardial infarction (MI), cerebrovascular event, and systemic embolic event at 90 days [11.3% vs. 21.9%, P = 0.002; odds ratio (OR) 0.45; 95% confidence interval (CI) 0.27-0.76]. The alert reduced the odds of MI at 90 days by 87% (1.2% vs. 8.6%, P = 0.0002; OR 0.13; 95% CI 0.04-0.45) and cerebrovascular events or systemic embolism at 90 days by 88% (0% vs. 2.4%, P = 0.02; OR 0.12; 95% CI 0.0-0.91). CONCLUSION An alert-based CDS strategy increased anticoagulation in high-risk hospitalized AF patients and reduced major adverse cardiovascular events, including MI and stroke. CLINICALTRIALS.GOV IDENTIFIER NCT02339493.

中文翻译：

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为未开具抗凝处方的房颤高危住院患者提供基于警报的计算机化决策支持：一项随机对照试验 (AF-ALERT)

AIMS 尽管风险分层工具、安全有效的抗凝剂选择和指南建议广泛可用，但房颤 (AF) 中用于预防卒中的抗凝剂处方不足。我们创建并评估了一种基于警报的计算机化决策支持 (CDS) 策略，以增加卒中高风险住院 AF 患者的抗凝处方。方法和结果 我们招募了 458 名 AF 患者（CHA2DS2-VASc 评分≥1），这些患者未接受抗凝治疗并在布莱根妇女医院住院。根据记录的主治医师，患者被随机分配到干预（基于警报的 CDS）与对照（无通知）。主要疗效结果是抗凝剂处方的频率。CDS 工具将 248 名患者分配到警报组，将 210 名分配到对照组。警报组的患者更有可能在住院期间（25.8% 对 9.5%，P < 0.0001）、出院时（23.8% 对 12.9%，P = 0.003）和 90 天（27.7%）接受抗凝治疗与 17.1%，P = 0.007）。该警报降低了 90 天时死亡、心肌梗死 (MI)、脑血管事件和全身栓塞事件的复合结果的几率 [11.3% 对 21.9%，P = 0.002；优势比 (OR) 0.45；95% 置信区间 (CI) 0.27-0.76]。该警报将 90 天时 MI 的几率降低了 87%（1.2% 对 8.6%，P = 0.0002；OR 0.13；95% CI 0.04-0.45）和 90 天时脑血管事件或全身栓塞的几率降低了 88%（0%对比 2.4%，P = 0.02；OR 0.12；95% CI 0.0-0.91）。结论 基于警报的 CDS 策略增加了高危住院 AF 患者的抗凝作用，并减少了主要的不良心血管事件，包括 MI 和中风。CLINICALTRIALS.GOV 标识符 NCT02339493。