Lee Po-Tseng, Huang Mu-Hsiang, Huang Ting-Chun, Sung Pi-Shan, Hsu Chi-Hui, Huang Ya-Ling, Lin Sheng-Hsian, Liu Ping-Yen
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University Tainan Taiwan.
Division of Cardiology, Department of Internal Medicine National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan.
J Am Heart Assoc. 2025 Aug 5;14(15):e038640. doi: 10.1161/JAHA.124.038640. Epub 2025 Jul 29.
Improving adherence to oral anticoagulants (OACs) is vital for patients with atrial fibrillation. While clinical decision support systems (CDSSs) have shown benefits among hospitalized patients with atrial fibrillation, their real-world effect in outpatient care remains unclear.
This single-center, observational study evaluated the impact of an atrial fibrillation CDSS implemented in outpatient clinics since 2017. The system generated alerts recommending anticoagulation based on CHA₂DS₂-VASc and HAS-BLED scores. We compared OAC prescribing patterns, stroke incidence, and major bleeding events before (n=3344) and after (n=3859) CDSS implementation, involving 7203 patients with atrial fibrillation over a 5-year period.
OAC prescription rates increased from 47.3% to 67.5% after CDSS implementation. Direct OAC use rose from 34.6% to 64.4%, while warfarin use declined from 14.1% to 6.4%. Stroke incidence showed a nonsignificant decline (adjusted hazard ratio [HR], 1.28 [95% CI, 0.67-2.46]; =0.457). Major bleeding events significantly decreased (adjusted HR, 2.07 [95% CI, 1.60-2.68]; <0.001).
Outpatient implementation of an atrial fibrillation CDSS was associated with increased OAC use and reduced major bleeding events, potentially due to the replacement of warfarin with a direct OAC. Although the adoption of direct OACs was already increasing, the implementation of the CDSS supported more guideline-adherent anticoagulation prescribing, particularly in high-volume outpatient settings. Further studies are warranted to assess its long-term effect on patient outcomes.
提高口服抗凝药（OAC）的依从性对房颤患者至关重要。虽然临床决策支持系统（CDSS）已在住院房颤患者中显示出益处，但其在门诊护理中的实际效果仍不明确。
这项单中心观察性研究评估了自2017年起在门诊实施的房颤CDSS的影响。该系统根据CHA₂DS₂-VASc和HAS-BLED评分生成抗凝治疗推荐警报。我们比较了CDSS实施前（n = 3344）和实施后（n = 3859）的OAC处方模式、卒中发生率和大出血事件，研究涉及7203例房颤患者，为期5年。
CDSS实施后，OAC处方率从47.3%提高到67.5%。直接口服抗凝药的使用从34.6%升至64.4%，而华法林的使用从14.1%降至6.4%。卒中发生率呈非显著性下降（校正风险比[HR]，1.28[95%CI，0.67 - 2.46]；P = 0.457）。大出血事件显著减少（校正HR，2.07[95%CI，1.60 - 2.68]；P < 0.001）。
门诊实施房颤CDSS与OAC使用增加及大出血事件减少相关，这可能是由于直接口服抗凝药取代了华法林。尽管直接口服抗凝药的采用率已经在上升，但CDSS的实施支持了更多符合指南的抗凝处方，尤其是在大量门诊患者中。有必要进一步研究评估其对患者预后的长期影响。
