Observational studyJournal of the American Heart Association2025
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.
Observational study in Journal of the American Heart Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Integrated care management and comprehensive geriatric assessment using a mHealth-based approach in older multimorbid patients with atrial fibrillation: the AFFIRMO cluster-randomised trial.The Lancet regional health. Europe · 2026Article
- [Application and challenges of the clinical decision support system in hematological diseases].Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi · 2026Review
- Impact of different doses of rivaroxaban on clinical outcomes in elderly patients with non-valvular atrial fibrillation: a real-world study.Frontiers in pharmacology · 2025Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundImproving 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.
methodsThis 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.
resultsOAC 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];
conclusionsOutpatient 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.
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