A simple pop-up alert on a computer screen could help save the brains and hearts of many hospital-bound people with an irregular heartbeat, a new clinical trial reveals. Rates for heart attack and stroke plunged by close to 90% in people helped by the new program, the study found.

The computer alert warns doctors of the high stroke risk by individual patients who suffer from atrial fibrillation, a quivering heart rhythm that allows blood to pool and clot inside the heart. Doctors who received this alert were nearly three times as likely to prescribe blood thinners to hospitalized patients with a-fib, said Dr. Gregory Piazza, a cardiovascular specialist with Brigham and Women's Hospital in Boston.

As a result, rates for heart attack and stroke among the a-fib patients fell by 87% and 88%, respectively, over the three-month trial, Piazza's group reported Saturday at the American Heart Association's annual meeting in Chicago.

Atrial fibrillation

The magnitude of the reduction in risk of these life-threatening health problems, as it was "really beyond what we expected to see with the increase in anticoagulation," Piazza said. Blood thinners are very important to prevent stroke in a-fib patients, but prior studies say at least 30% have not prescribed such a medication, researchers said in background information.

For this study, piazza and his team created a program that analyzes computer data of patients with atrial fibrillation to calculate what is known as a CHADS-VASC score. This is a report from Dr. Mary Norine Walsh, medical director of the heart failure and cardiac transplantation program at the St. Vincent Heart Center in Indianapolis.

The test program issues to pop-up alert to doctors indicating that their patient has a high CHADS-VASC score. It even estimates their annual risk of stroke. The pop-up then requires doctors to either prescribe a blood thinner or give a reason why medicine should not be used. Possible reasons include "bleeding risk is too high," "patient is at high risk for falls," or "patient refuses anticoagulation."

To see if the alert would make a difference, the researchers randomly assigned 458 a-fib patients would have their records reviewed by the program. About 19% of patients in the alert group had a prescription for blood thinners during hospitalization, at discharge and three months later, found. By comparison, only 7% of the control group had prescribed blood thinners.

By three months after hospitalization, the alert group had a dramatic effect on patients' odds for heart attack or stroke, although that did not translate to a lessening of the death rate, the team noted. Still, the study showed that reminder systems like this really work to cut the odds for cardiac events, said Walsh, who is president of the American College of Cardiology.