Computerized decision support for the cardiovascular clinician: applications for venous thromboembolism prevention and beyond.

Abstract

A 76-year-old woman with coronary artery disease, left ventricular systolic dysfunction (ejection fraction = 30%), obesity, and a history of deep vein thrombosis presents with dyspnea and hypoxemia. The combination of physical examination findings of an S3, rales in the lower half of both lung fields, and peripheral edema, chest x-ray evidence of cardiomegaly and pulmonary edema, and a pro-brain-type natriuretic peptide level of 2,150 pg/mL (normal <350 pg/mL) confirms the diagnosis of decompensated heart failure. She is admitted to the Cardiology Service for diuretic therapy and optimization of her heart failure regimen. Although she is written for bedrest, her admission orders do not include venous thromboembolism (VTE) prophylaxis. While entering orders, the Medical House Officer caring for the patient receives an electronic alert identifying the patient as high-risk for VTE and recommending that she be prescribed prophylaxis.