Electronic Alert Tells MDs Afib Patients Need Drugs

Researchers have found that using an electronic alert system improves the rate at which hospitalized patients with atrial fibrillation (AF) are prescribed oral anticoagulants (OAC) to prevent stroke and systemic embolism. A study, authored by Gunther Silbernagel, MD, of the Medical University of Graz, in Austria, and colleagues, was published in the Journal of the American Heart Association in July, 2016.

Patients with AF are at a greater risk of stroke, but treatment with OAC with vitamin K reduces that risk by approximately 80%. However, undertreatment and adherence to treatment are problems. In the present study, researchers investigated whether using an electronic alert system to make physicians aware of the problem would improve the rate at which OAC therapy was prescribed.

The first step was to develop the electronic system. The authors say, “The alert system automatically identified hospitalized patients with AF without an active OAC prescription in the electronic order entry system,” adding that the alert was incorporated into the existing computer system of the University Hospital in Bern, Switzerland.

Then, between September 2014 and October 2015, 1707 patients were randomly assigned to an alert group or a control group. There were 889 patients with AF who were not prescribed OAC. The researchers say, “Overall, 100 (22.0%) patients from the alert group versus 60 (15.9%) from the control group received an adequate OAC prescription.”

The results of this study, along with one previously conducted regarding electronic alerts to prevent venous thromboembolism, “there is increasing evidence supporting the implementation of computerized decision support systems in cardiovascular medicine,” according to the researchers.

One limitation of the alert system “was the high rate of non-sense alerts for patients who were not OAC-naive because alerts were often not issued before anticoagulation treatment was ordered through the electronic prescription system,” say the authors. However, the problem was solved by changing the system to send alerts 24 hours after hospital admission rather than immediately upon admission.

“An increase in the prescription rate of anticoagulant treatment in AF may translate into a reduction of the future risk of stroke,” say the researchers. They further suggest the results of this trial may motivate hospitals with electronic patient record systems to consider implementing a similar alert system for patients with AF.