An alert-based computerized decision support system to increase anticoagulation for stroke prevention in high-risk hospitalized atrial fibrillation (AFib) patients may reduce major adverse cardiovascular events, according to results of the AF-ALERT trial, presented Nov. 10 at AHA 2018 in Chicago, IL.

Gregory Piazza, MD, FACC, et al., looked at 457 hospitalized high-risk patients (CHA2DS2-VASc score≥1) ≥21 years with AFib or atrial flutter who were not prescribed anticoagulant therapy for stroke prevention. Patients were randomly assigned to an alert-based computerized decision support system vs. usual care.

Results showed that patients in the decision support system group were more likely to be prescribed anticoagulation during the hospitalization, at discharge and at 90 days. Overall, the alert reduced the odds of a composite outcome of death, myocardial infarction (MI), cerebrovascular event, and systemic embolic event at 90 days. Further, the alert reduced the frequency of MI and stroke at 90 days by 87 percent and 88 percent, respectively.

The researchers conclude that "an alert-based computerized decision support strategy increased prescription of anticoagulation in hospitalized patients with AFib who were not receiving antithrombotic therapy despite an increased risk of stroke." They add that moving forward, "implementation of an alert-based computerized decision support, when feasible, should be considered an indispensable tool to reduce major adverse cardiac events in patients with AFib."

Meanwhile, the IMPACT AF trial, also presented Nov. 10 at AHA 2018, showed that there was little effect on time to AFib-related ED visit or unplanned cardiovascular hospitalizations for primary care physicians using a computer decision support system vs. usual care.

Jafna L. Cox, MD, FACC, et al., looked at 1,145 patients with AFib who were randomized to an online evidence-based clinical decision support system or usual care. Results showed that the clinical decision support system intervention had "no significant effect on the number of patients experiencing the composite of unplanned cardiovascular hospitalization and/or AFib-related emergency room visit at 12 months."

However, the researchers note that the "incident rate ratios suggest the potential for marked reductions in events with such tools, but more and better user training and longer duration of use will be required to confirm this."

Clinical Topics: Arrhythmias and Clinical EP, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: AHA18, AHA Annual Scientific Sessions, Chronic Disease, Telemedicine, Primary Health Care, Atrial Fibrillation

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