Improved Anticoagulation Guideline Adherence and Clinical Outcome Through Hospital-Wide Atrial Fibrillation Alarming System.

Background: Direct oral anticoagulation (DOAC) therapy has been approved for stroke prevention in atrial fibrillation (AF) patients. However, about 30% of patients with AF are not on oral anticoagulants (OACs). About 30% of patients on OACs are on off-label dosages. Objective: We used a hospital-wide AF screening system to improve the OAC guideline adherence rate. We also assessed the impact on clinical outcomes. Methods: All electrocardiograms (ECGs) of each hospitalized patient were screened using an AF screening system, regardless of whether the ECGs were obtained during or before hospitalization. Patients with AF were enrolled. The CHA Results: At baseline, the DOAC guideline adherence rate was only 40.6%. After the intervention, the guideline adherence rate increased to 82.5%. After discharge, the adherence rate did not decrease. The annual stroke rates for patients on guideline-recommended DOACs with and without our intervention were 2.79% and 3.12%, respectively. The annual stroke rate for patients on DOACs not adhering to the guidelines was 9.91%. The minor bleeding rate was significantly higher in the groups that adhered to the guidelines, but the major bleeding rate was not significantly different. Conclusions: Implementation of a hospital-wide AF screening system improved the DOAC guideline adherence rate and reduced the annual stroke rate for patients with AF. The minor bleeding rate was increased.