Evaluation of physician alerts to improve treatment for prevention of stroke in atrial fibrillation patients

Background Oral anticoagulants reduce stroke risk in atrial fibrillation (AF) patients, yet a 25%–35% treatment gap exists for high-risk individuals. To address this, an automated electronic health record alert was implemented for untreated AF patients meeting guideline criteria (CHA 2 DS 2 VASc score ≥2 for males, ≥3 for females) with no prior history of anticoagulant purchase. Objective This study evaluated the efficacy of the clinical decision support alert in promoting anticoagulant prescribing—specifically direct oral anticoagulants (DOACs)—to align treatment with international standards. Materials and methods This retrospective cohort study analyzed demographic, socioeconomic, and prescription dispensing data. Alert effectiveness was defined as the percentage of patients who successfully purchased anticoagulants following a physician-received alert during a clinical visit. Results The alert triggered for 2,412 patients (mean age 74.6 ± 9.0 years; 41.5% female). Only 0.43% of alerts were actively declined by physicians for medical reasons, confirming high clinical appropriateness. Overall, 26.53% ( n = 640) of targeted patients subsequently purchased DOACs. However, equitable gaps remained, as Arabs and females were significantly less likely to receive prescriptions. Conclusion An automated alert reached AF patients whom guideline recommendations alone had not, and narrowed but did not close the anticoagulant treatment gap. The remaining gap lies mainly in the consultation rather than in patient identification, and is wider among women and in the Arab sector.