Starting anticoagulation for atrial fibrillation in the emergency department safely

Kirwan, Christopher; Ramsden, Sophie; Carter, Jaimee; Tong, X Catherine; Huang, Johnny W.; Clayton, Natasha; McArthur, Robyn; Kibria, Aqsa; Wit, Kerstin de

doi:10.1136/emermed-2022-212487

Cited by 3 publications

(4 citation statements)

References 6 publications

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“…11,13 However, multiple studies have shown that the rate of prescribing OAC in the ED is still very low. 10,13,14 The findings of this study were similar to a recent review of health records of patients diagnosed with new-onset AF in 2 EDs in Canada where they found, only 17% of 272 patients indicated for AC left the ED with a prescription of OAC. 14 The barriers to initiating AC in the ED have been discussed in previous studies and have found similar results to this study.…”

Section: Discussionsupporting

confidence: 87%

“…10,13,14 The findings of this study were similar to a recent review of health records of patients diagnosed with new-onset AF in 2 EDs in Canada where they found, only 17% of 272 patients indicated for AC left the ED with a prescription of OAC. 14 The barriers to initiating AC in the ED have been discussed in previous studies and have found similar results to this study. A recent study found that 52% of ED providers believed that a new AC prescription is the responsibility of the PCP.…”

Section: Discussionsupporting

confidence: 87%

“…13 It was also noted that patients who start AC in the ED are more likely to fill their prescriptions as opposed to patients who discharge from the ED without starting AC. 13,14…”

Section: Discussionmentioning

confidence: 99%

“…13 It was also noted that patients who start AC in the ED are more likely to fill their prescriptions as opposed to patients who discharge from the ED without starting AC. 13,14 Targeted emergency physicians' education with updated guidelines and proper utilization of accessible services like AMS for more intensive follow-up are important measures to support the initiation of OAC in the ED. Furthermore, an institutional pathway for patients with newly diagnosed AF in the ED is one way this problem could be targeted.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Assessment of Anticoagulant Initiation in Patients With New-Onset Atrial Fibrillation During Emergency Department Visit

Habeeb

Papadopoulos

Lewin

et al. 2023

Clin Appl Thromb Hemost

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Patients with atrial fibrillation (AF) have an increased risk of stroke and systemic thromboembolism. Diagnosis of AF is commonly encountered in the emergency department (ED). The purpose of this study was to assess the number of patients with new-onset AF appropriately initiated on oral anticoagulation (AC) during their ED encounter. This retrospective analysis included patients discharged from the ED from July 2016 to July 2021 with a new diagnosis of AF. Patients were excluded if they were on AC before admission. The major endpoint was to identify the percentage of patients discharged from the ED without initiating AC. Minor endpoints included the average CHA2DS2-VASc scores and the reason for not initiating AC. A total of 380 patients were included in the final analysis. Of the 245 patients found to be indicated for AC, only 131 patients (53.5%) were initiated on AC and 114 patients (46.5%) were discharged without initiating AC. Almost half of the patients who presented to the ED with a new diagnosis of AF and indicated for AC were discharged without AC.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

“…13 It was also noted that patients who start AC in the ED are more likely to fill their prescriptions as opposed to patients who discharge from the ED without starting AC. 13,14…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of Anticoagulant Initiation in Patients With New-Onset Atrial Fibrillation During Emergency Department Visit

Habeeb

Papadopoulos

Lewin

et al. 2023

Clin Appl Thromb Hemost

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Anticoagulation prescription among atrial fibrillation patients managed with and without an anticoagulant initiation pathway: a cohort study

Carter,

Kirwan,

Niaz

et al. 2023

European Journal of Emergency Medicine

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Background and importance The Canadian Association of Emergency Physicians atrial fibrillation (AF) checklist advises that emergency physicians initiate anticoagulation therapy for patients with AF or flutter who are CHADS65 positive. Objectives The aim was to compare anticoagulation initiation rates between patients treated with and without an anticoagulation assessment pathway (the SAFE pathway). Design This was a retrospective cohort study. Settings and participants All emergency department patients were discharged home with a diagnosis of AF between June 2018 and May 2020 at two Canadian emergency departments. Intervention The SAFE pathway is a hard copy form which allows emergency physicians to document contraindications to anticoagulation, the positive components of the CHADS65 score, and details how to prescribe anticoagulation. Outcome measures and analysis Trained researchers abstracted data on the use of the SAFE pathway by the presence or absence of the completed, scanned pathway in the electronic medical chart. The exposure of interest was use of this pathway. Patients were followed forward in time for 90 days by electronic medical record review to document stroke, transient ischemic attack, arterial embolism and major bleeding events. All events were independently adjudicated. Adjusted odds ratios were calculated to compare outcomes between those managed with and without the SAFE pathway. Results In total, 766 patients were included, of whom 264 were already taking anticoagulation, 166 were CHADS65 negative and 65 had a contraindication to anticoagulation, leaving 271 patients eligible for anticoagulation prescription. Among the 271 eligible patients, 137/166 managed with the SAFE pathway were initiated on anticoagulation and 24/105 managed without the SAFE pathway started anticoagulation (adjusted odds ratio 25.9; 13.1–51.2). There was no statistically significant difference in the 90-day rate of stroke or bleeding. Conclusion Use of the SAFE pathway was associated with a higher rate of anticoagulation prescription.

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Eligibility for anticoagulation initiation in atrial fibrillation: Agreement between emergency physician and medical record review

Seeburruth,

Tong,

Kirwan

et al. 2024

Academic Emergency Medicine

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Starting anticoagulation for atrial fibrillation in the emergency department safely

Cited by 3 publications

References 6 publications

Assessment of Anticoagulant Initiation in Patients With New-Onset Atrial Fibrillation During Emergency Department Visit

Assessment of Anticoagulant Initiation in Patients With New-Onset Atrial Fibrillation During Emergency Department Visit

Anticoagulation prescription among atrial fibrillation patients managed with and without an anticoagulant initiation pathway: a cohort study

Eligibility for anticoagulation initiation in atrial fibrillation: Agreement between emergency physician and medical record review

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