{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:08:00Z","timestamp":1781237280289,"version":"3.54.1"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Anticoagulation decisions in atrial fibrillation (AF) depend on balancing stroke and bleeding risk, often guided by CHA2DS2-VASc (a validated clinical score used to estimate stroke risk in patients with atrial fibrillation) and HAS-BLED (a validated clinical score used to estimate bleeding risk in patients treated with anticoagulation) scores. Manual calculation of these scores can be time-consuming and inconsistently performed.<\/jats:p>\n                  <jats:p>This study evaluated whether implementing real-time, electronic health record (EHR)-integrated alerts in a rural academic primary care clinic would influence physician and non-physician provider (NPP) behavior around anticoagulation management.<\/jats:p>\n                  <jats:p>A single-arm observational study was conducted from March 2024 to September 2025 at a West Virginia University (WVU) Family Medicine Clinic. A rules-based engine in Epic calculated risk scores using 1 year of structured data and displayed them within a non-interruptive \u201cOur Practice Advisory\u201d alert. Physician or NPP interaction\u2014defined as initiation of anticoagulation, documentation of rationale, or adding exclusion diagnosis to problem list\u2014was analyzed using chi-square testing.<\/jats:p>\n                  <jats:p>Among 313 patients triggering the alert, 53 (16.9%) were newly started on anticoagulation, 112 (35.8%) had a documented rationale for not initiating therapy, and 2 had the exclusion diagnosis added to their chart. In total, 50.5% of patients had a clinically meaningful interaction with the tool (\u03c72\u2009=\u20099.82, p\u2009=\u20090.0017). Across 2,447 encounters, the overall alert success rate was 19.8%, reflecting encounter-level engagement. Common acknowledgment reasons included corrective measures completed, high bleeding risk, recent procedures, and patient refusal. Physician and NPP comments informed iterative refinement, leading to expanded acknowledgment options.<\/jats:p>\n                  <jats:p>Real-time alerts displaying stroke and bleeding risk scores were associated with meaningful physician and NPP engagement, particularly for initiating anticoagulation in high-risk patients. While most interactions reflected review rather than treatment change, the tool appeared to support point-of-care decision-making. These findings support further investigation of EHR-based advisories to improve anticoagulation management in AF.<\/jats:p>","DOI":"10.1055\/a-2765-6969","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:26:36Z","timestamp":1766103996000},"page":"1892-1899","source":"Crossref","is-referenced-by-count":1,"title":["Effect of Clinical Decision Support Alerts on Anticoagulation Management in Atrial Fibrillation"],"prefix":"10.1055","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9230-3950","authenticated-orcid":false,"given":"Joseph E.","family":"Capito","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, West Virginia University, Morgantown, West Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian Z.","family":"Dilcher","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zulkifl I.","family":"Jafary","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, West Virginia University, Morgantown, West Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"issue":"08","key":"ref1","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1161\/01.STR.22.8.983","article-title":"Atrial fibrillation as an independent risk factor for stroke: The Framingham Study","volume":"22","author":"P A Wolf","year":"1991","journal-title":"Stroke"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.thromres.2023.05.006","article-title":"Electronic alerts for ambulatory patients with atrial fibrillation not prescribed anticoagulation: A randomized, controlled trial (AF-ALERT2)","volume":"227","author":"G Piazza","year":"2023","journal-title":"Thromb 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Mak"},{"issue":"10","key":"ref6","doi-asserted-by":"crossref","first-page":"e2238231","DOI":"10.1001\/jamanetworkopen.2022.38231","article-title":"Effect of electronic health record clinical decision support on contextualization of care: A randomized clinical trial","volume":"5","author":"S J Weiner","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"01","key":"ref8","first-page":"209","article-title":"Comparative effectiveness of best practice alerts with active and passive presentations: A retrospective study","volume":"64","author":"S N Valvona","year":"2020","journal-title":"Proc Hum Factors Ergon Soc Annu Meet"},{"issue":"10","key":"ref9","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1093\/eurheartj\/ehz385","article-title":"Alert-based computerized decision support for high-risk hospitalized patients with atrial fibrillation not prescribed anticoagulation: A randomized, controlled trial (AF-ALERT)","volume":"41","author":"G Piazza","year":"2020","journal-title":"Eur Heart J"},{"issue":"17","key":"ref10","doi-asserted-by":"crossref","first-page":"e009946","DOI":"10.1161\/JAHA.118.009946","article-title":"SUPPORT-AF: Piloting a multi-faceted, electronic medical record-based intervention to improve prescription of anticoagulation","volume":"7","author":"A Kapoor","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ahj.2017.02.009","article-title":"Clinical decision support for stroke prevention in atrial fibrillation (CDS-AF): Rationale and design of a cluster randomized trial in the primary care setting","volume":"187","author":"L O Karlsson","year":"2017","journal-title":"Am Heart J"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ahj.2020.02.019","article-title":"Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF): A cluster randomized trial of a computerized clinical decision support tool","volume":"224","author":"J L Cox","year":"2020","journal-title":"Am Heart J"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1161\/CIR.0000000000001193","article-title":"2023 ACC\/AHA\/ACCP\/HRS Guideline for the diagnosis and management of atrial fibrillation: A report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"149","author":"J A Joglar","year":"2024","journal-title":"Circulation"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.chest.2018.07.040","article-title":"Antithrombotic therapy for atrial fibrillation: CHEST guideline and expert panel report","volume":"154","author":"G YH Lip","year":"2018","journal-title":"Chest"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"e366","DOI":"10.1016\/j.amjmed.2020.11.024","article-title":"Oral anticoagulation use in high-risk patients is improved by elimination of false-positive and inactive atrial fibrillation cases","volume":"134","author":"G V Naccarelli","year":"2021","journal-title":"Am J Med"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"G Hindricks","year":"2021","journal-title":"Eur Heart J"},{"issue":"07","key":"ref17","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1093\/jamia\/ocac043","article-title":"Impact of longitudinal data-completeness of electronic health record data on risk score misclassification","volume":"29","author":"Y Jin","year":"2022","journal-title":"J Am Med Inform Assoc"}],"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2765-6969.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:26:47Z","timestamp":1766104007000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2765-6969"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":16,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2025,10,17]]},"published-print":{"date-parts":[[2025,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2765-6969","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1869-0327"],"issn-type":[{"value":"1869-0327","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]}}}