Silbernagel Günther, Spirk David, Hager Adrian, Baumgartner Iris, Kucher Nils
Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria Department of Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Switzerland.
Institute of Pharmacology, University of Bern, Switzerland.
J Am Heart Assoc. 2016 Jul 22;5(7):e003776. doi: 10.1161/JAHA.116.003776.
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.
许多心房颤动（AF）患者未接受口服抗凝药（OAC）以预防中风和全身性栓塞。我们旨在改善住院AF患者的OAC处方情况。
我们开发了一种基于计算机的电子警报系统，用于识别未接受过OAC治疗的住院AF患者。该警报系统包含CHA2DS2-VASc评分计算工具，并提供OAC处方建议。该警报系统在伯尔尼大学医院进行了1:1随机对照试验：疑似AF但无现行处方医嘱的患者被分配至警报组，在电子病历和医嘱录入系统中发出警报，或分配至对照组，不发出警报。主要终点是出院时适当OAC处方的比例，定义为CHA2DS2-VASc评分分别≥1和≥2的未接受过OAC治疗的男性和女性患者开具OAC处方。总体而言，889例未接受过OAC治疗的患者（警报组455例，对照组434例）符合分析条件。尽管警报组仅48例（10.5%）患者使用了CHA2DS2-VASc评分模块，但警报组100例（22.0%）患者与对照组69例（15.9%）患者接受了适当的OAC处方（相对风险1.38；P=0.021）。警报组325例（71.4%）患者开具了OAC或抗血小板治疗药物，而对照组为271例（62.4%）（P=0.004）。
与标准治疗相比，警报系统适度改善了连续住院AF患者的OAC处方情况。
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