Abstract Background Clinical decision support systems (CDSS) have been utilized as a low-cost intervention to improve healthcare process measures.Thus, we aim to estimate CDSS efficacy to optimize adherence to oral anticoagulant guidelines in eligible patients with atrial fibrillation (AF).Methods A systematic review red pygmy dogwood and meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through August 2023.We used RevMan V.5.
4 to pool dichotomous data using risk ratio (RR) with a 95% confidence interval (CI).PROSPERO ID: CRD42023471806.Results We included nine RCTs with a total of 25,573 patients.There was no significant difference, with the use of CDSS compared to routine care, in the number of patients prescribed anticoagulants (RR: 1.06, 95% CI [0.
98, 1.14], P = 0.16), the number of patients prescribed antiplatelets (RR: 1.01 with 95% CI [0.97, 1.
06], P = 0.59), all-cause mortality (RR: 1.19, 95% CI [0.31, 4.50], P = 0.
80), major bleeding (RR: 0.84, 95% CI [0.21, 3.45], P = 0.81), and clinically relevant non-major bleeding (RR: 1.
05, 95% ngetikin CI [0.52, 2.16], P = 0.88).However, CDSS was significantly associated with reduced incidence of myocardial infarction (RR: 0.
18, 95% CI [0.06, 0.54], P = 0.002) and cerebral or systemic embolic event (RR: 0.11, 95% CI [0.
01, 0.83], P = 0.03).Conclusion We report no significant difference with the use of CDSS compared to routine care in anticoagulant or antiplatelet prescription in eligible patients with AF.CDSS was associated with a reduced incidence of myocardial infarction and cerebral or systemic embolic events.