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Published on: February 26, 2013
Assessment of Anticoagulant Initiation in Patients With New-Onset Atrial Fibrillation During Emergency Department
Ehsan Habeeb1,2, Themio Papadopoulos3, Andrea R Lewin1
1Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
Insights
Nearly half of emergency department patients diagnosed with new-onset atrial fibrillation (AF) who needed oral anticoagulation (AC) were discharged without it. This highlights a gap in stroke prevention for AF patients.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Background:
- Atrial fibrillation (AF) significantly increases stroke and thromboembolism risk.
- Emergency departments (EDs) frequently diagnose new-onset AF.
- Timely initiation of oral anticoagulation (AC) is crucial for stroke prevention in AF patients.
Purpose of the Study:
- To evaluate the rate of oral anticoagulation (AC) initiation in patients with new-onset atrial fibrillation (AF) during emergency department (ED) encounters.
- To identify the proportion of indicated patients discharged from the ED without AC.
- To analyze factors contributing to the lack of AC initiation.
Main Methods:
- Retrospective analysis of patients diagnosed with new-onset AF and discharged from the ED between July 2016 and July 2021.
- Exclusion of patients already on AC prior to admission.
- Assessment of AC indication using CHA2DS2-VASc scores and documentation of reasons for non-initiation.
Main Results:
- 380 patients were analyzed; 245 required AC.
- Only 131 patients (53.5%) were initiated on AC.
- 114 patients (46.5%) were discharged from the ED without AC initiation.
Conclusions:
- A significant proportion of emergency department patients with new-onset atrial fibrillation who are indicated for anticoagulation are not initiated on therapy before discharge.
- This represents a critical missed opportunity for stroke risk reduction.
- Further investigation into barriers and interventions is needed to improve AC prescribing rates in the ED setting.
Abstract:
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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