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Published on: February 26, 2013
Factors Associated with Anticoagulation Initiation for New Atrial Fibrillation in an Urban Emergency Department
Johanna Seiden1, Samantha Lessen2, Natalie T Cheng3
1Department of Neurology, New York University Grossman School of Medicine, New York, NY.
Insights
Anticoagulation (AC) was initiated in over half of emergency department patients diagnosed with atrial fibrillation (AF). Factors like non-English language and leaving against medical advice were linked to not starting AC.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Atrial fibrillation (AF) is a common arrhythmia associated with increased stroke risk.
- Anticoagulation (AC) therapy is crucial for stroke prevention in AF patients.
- Initiation of AC after emergency department (ED) diagnosis of new-onset AF requires further investigation.
Purpose of the Study:
- To explore factors associated with anticoagulation (AC) initiation after emergency department (ED) diagnosis of new-onset atrial fibrillation (AF).
Main Methods:
- Retrospective cohort study of adult patients diagnosed with new-onset AF in the ED.
- Compared patients initiated on AC versus those not initiated.
- Analyzed secondary outcomes including stroke, major bleeding, and delayed AC initiation.
Main Results:
- 56% of eligible patients were initiated on AC.
- Factors associated with no AC initiation included younger age, non-English language preference, leaving the ED against medical advice (AMA), and lower CHA2DS2-VASc scores.
- Cardiology consultation and higher CHA2DS2-VASc scores were associated with AC initiation.
- No association was found between patient-reported race/ethnicity and AC initiation.
Conclusions:
- Over half of ED patients with new AF received AC, but opportunities exist to improve utilization.
- Interventions may be warranted for patients leaving AMA or with non-English language preferences.
- Further research can optimize AC initiation in this population.
Objective:
To explore factors associated with anticoagulation (AC) initiation after atrial fibrillation (AF) diagnosis.
Design:
Retrospective cohort study.
Setting:
Urban medical center.
Patients:
Adults with emergency department (ED) diagnosis of new onset AF from 1/1/2017-1/1/2020 discharged home.
Methods:
We compared patients initiated on AC, our primary outcome, to those not initiated on AC. Stroke, major bleeding, and AC initiation within 1 year of visit were secondary outcomes. We hypothesized that minority race and non-English language preference are associated with failure to initiate AC.
Results:
Of 111 patients with AF, 88 met inclusion criteria. Mean age was 65 (SD 15); 47 (53%) were women. 49 (56%) patients were initiated on AC. Age (61 vs 68 years; P=.02), non-English language (28% vs 10%; P=.03), leaving ED against medical advice (AMA) (36% vs 14%; P=.04), and CHA2DS2-VASc score of 1 (41% vs 6%; P<=.001) were associated with no AC initiation. There were no associations between patient-reported race/ethnicity and AC. Cardiology consultation (83.67% vs 30.78%; P<.0001) and higher median CHA2DS2-VASc score (3[2-4]) vs. 2[1-4]; P=.047) were associated with AC. Of 73 patients with follow-up data at 1 year, 2 (8%) not initiated on AC had strokes, 2 (4%) initiated on AC had major bleeds, and 15 (62.5%) not initiated on AC in the ED subsequently were initiated on AC.
Conclusion:
More than half of ED patients with new AF eligible for AC were initiated on it. Work to improve AC utilization among patients with new AF who left AMA from ED and those who prefer to communicate in a non-English language may be warranted.
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