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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Identification and early anticoagulation in patients with atrial fibrillation in the emergency department

Kim Schwab1, Richard Smith2, Eric Wager3

  • 1Sharp Chula Vista Medical Center, Chula Vista, CA, United States of America.

The American Journal of Emergency Medicine
|April 26, 2020
PubMed

Insights

A multidisciplinary team approach significantly improved guideline-recommended anticoagulation prescribing for atrial fibrillation patients in the emergency department, closing a critical treatment gap for stroke prevention.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Pharmacology

Background:

  • Emergency departments (ED) encounter over 500,000 atrial fibrillation (AF) visits annually in the US.
  • Guideline-recommended anticoagulation is underprescribed in less than 55% of eligible AF patients.
  • A significant treatment gap exists in anticoagulation therapy for AF patients presenting to the ED.

Purpose of the Study:

  • To measure guideline-recommended anticoagulation prescribing in nonvalvular atrial fibrillation (NVAF) patients in the ED.
  • To assess the effectiveness of a multidisciplinary team approach in closing the anticoagulation treatment gap.
  • To compare anticoagulation prescribing between routine care and a multidisciplinary team intervention.

Main Methods:

  • An observational, prospective cohort study design was employed.
  • CHA2DS2-VASc and HAS-BLED scores determined guideline-based oral anticoagulation (OAC) compliance.
  • A multidisciplinary team approach with Transition of Care (TOC) services was compared to routine care (baseline cohort).

Main Results:

  • Guideline-based OAC discharge rates were 62.3% in the baseline cohort (n=99) versus 87.8% in the multidisciplinary team cohort (n=131).
  • The multidisciplinary approach resulted in a 25.5% improvement in appropriate anticoagulation prescribing (p < .001).
  • This improvement was statistically significant, with a 95% confidence interval of (0.14-0.37).

Conclusions:

  • A multidisciplinary team approach, including TOC services, enhances identification and early intervention for NVAF patients at stroke risk in the ED.
  • This strategy significantly increases the proportion of moderate to high-risk patients discharged with guideline-based OAC.
  • Implementing such a team approach can effectively close the treatment gap in anticoagulation for NVAF patients.
Abstract

Keywords:
Emergency DepartmentGuideline based anticoagulationNonvalvular atrial fibrillation (NVAF)Oral anticoagulationTransition of Care

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