Improvement of Oral Anticoagulant Prescription and Long-Term Clinical Outcomes of Patients With Atrial Fibrillation After Implementation of a Clinical Decision Support System in Outpatient Practice.

BACKGROUND

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.

METHODS

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.

RESULTS

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]; P=0.457). Major bleeding events significantly decreased (adjusted HR, 2.07 [95% CI, 1.60-2.68]; P<0.001).

CONCLUSIONS

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.