Arrhythmias & electrophysiology
Alert-based computerized decision support for high-risk hospitalized patients with atrial fibrillation not prescribed anticoagulation: a randomized, controlled trial (AF-ALERT)
Authors' conclusion
An alert-based CDS strategy increased anticoagulation in high-risk hospitalized AF patients and reduced major adverse cardiovascular events, including MI and stroke.
Study context
- Population
- Hospitalized atrial fibrillation (AF) patients (CHA2DS2-VASc score ≥1) not prescribed anticoagulant therapy, Brigham and Women's Hospital
- Participants
- 458 patients
- Comparison
- Alert-based computerized decision support vs no notification
- Alertn = 248
- Controln = 210reference
- Primary endpoint
- Frequency of anticoagulant prescription
Methodological detailsrandomised by attending physician
- Randomised by attending physician
Primary result
As reported in the abstract
Anticoagulant prescription during hospitalization · during the hospitalization
P < 0.0001
Further findings
Anticoagulant prescription at discharge
P = 0.003
Anticoagulant prescription at 90 days
P = 0.007
Cerebrovascular events or systemic embolism · 90 days · odds reduced by 88%
OR 0.12 (0.0–0.91) · P = 0.02
| Outcome | Alert | Control | OR (95% CI) | P value | |
|---|---|---|---|---|---|
| Composite of death, MI, cerebrovascular event and systemic embolic event · 90 days | 11.3% | 21.9% | 0.45 (0.27–0.76) | P = 0.002 | |
| MI · 90 daysOdds reduced by 87% | 1.2% | 8.6% | 0.13 (0.04–0.45) | P = 0.0002 | |
| 0.050.21520Odds ratio (log scale) |
Original publication
Alert-based computerized decision support for high-risk hospitalized patients with atrial fibrillation not prescribed anticoagulation: a randomized, controlled trial (AF-ALERT). Eur Heart J. Published 22 June 2019. doi:10.
Summarised from the published abstract; every number is checked against it