Ratika Parkash1, Kirk Magee2, Mark McMullen2, Michael Clory2, Michel D'Astous3, Martin Robichaud3, Gary Andolfatto4, Brandi Read4, Jia Wang5, Lehana Thabane6, Clare Atzema7, Paul Dorian8, Janusz Kaczorowski9, Davina Banner10, Robby Nieuwlaat5, Noah Ivers11, Thao Huynh12, Janet Curran2, Ian Graham13, Stuart Connolly5, Jeff Healey5. 1. QEII Health Sciences Center, Halifax, Nova Scotia, Canada. Electronic address: ratika.parkash@nshealth.ca. 2. QEII Health Sciences Center, Halifax, Nova Scotia, Canada. 3. George-Dumont Hospital, Moncton, New Brunswick, Canada. 4. Lion's Gate Hospital, North Vancouver, British Columbia, Canada. 5. Population Health Research Institute, Hamilton, Ontario, Canada. 6. Population Health Research Institute, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. 7. Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. 8. St. Michael's Hospital, Toronto, Ontario, Canada. 9. Université de Montréal, Montreal, Quebec, Canada. 10. University of Northern British Columbia, Prince George, British Columbia, Canada. 11. University of Toronto, Toronto, Ontario, Canada. 12. McGill University Health Center, Montreal, Quebec, Canada. 13. University of Ottawa, Ottawa, Ontario, Canada.
Abstract
STUDY OBJECTIVE: Lack of oral anticoagulation prescription in the emergency department (ED) has been identified as a care gap in atrial fibrillation patients. This study seeks to determine whether the use of a tool kit for emergency physicians with a follow-up community-based atrial fibrillation clinic resulted in greater oral anticoagulation prescription at ED discharge than usual care. METHODS: This was a before-after study in 5 Canadian EDs in 3 cities. Patients who presented to the ED with atrial fibrillation were eligible for inclusion. The before phase (1) was retrospective; 2 after phases (2 and 3) were prospective: phase 2 used an oral anticoagulation prescription tool for emergency physicians and patient education materials, whereas phase 3 used the same prescription tool, patient materials, atrial fibrillation educational session, and follow-up in an atrial fibrillation clinic. Each phase was 1 year long. The primary outcome was the rate of new oral anticoagulation prescription at ED discharge for patients who were oral anticoagulation eligible and not receiving oral anticoagulation at presentation. RESULTS: A total of 631 patients were included. Mean age was 69 years (SD 14 years), 47.4% were women, and 69.6% of patients had a CHADS2 score greater than or equal to 1. The rate of new oral anticoagulation prescription in phase 1 was 15.8% compared with 54.1% and 47.2%, in phases 2 and 3, respectively. After multivariable adjustment, the odds ratio for new oral anticoagulation prescription was 8.03 (95% confidence interval 3.52 to 18.29) for phase 3 versus 1. The 6-month rate of oral anticoagulation use was numerically but not significantly higher in phase 3 compared with phase 2 (71.6% versus 79.4%; adjusted odds ratio 2.30; 95% confidence interval 0.89 to 5.96). The rate of major bleeding at 6 months was 0%, 0.8%, and 1% in phases 1, 2, and 3, respectively. CONCLUSION: An oral anticoagulation prescription tool was associated with an increase in new oral anticoagulation prescription in the ED, irrespective of whether an atrial fibrillation clinic follow-up was scheduled. The use of an atrial fibrillation clinic was associated with a trend to a higher rate of oral anticoagulation at 6-month follow-up.
STUDY OBJECTIVE: Lack of oral anticoagulation prescription in the emergency department (ED) has been identified as a care gap in atrial fibrillationpatients. This study seeks to determine whether the use of a tool kit for emergency physicians with a follow-up community-based atrial fibrillation clinic resulted in greater oral anticoagulation prescription at ED discharge than usual care. METHODS: This was a before-after study in 5 Canadian EDs in 3 cities. Patients who presented to the ED with atrial fibrillation were eligible for inclusion. The before phase (1) was retrospective; 2 after phases (2 and 3) were prospective: phase 2 used an oral anticoagulation prescription tool for emergency physicians and patient education materials, whereas phase 3 used the same prescription tool, patient materials, atrial fibrillation educational session, and follow-up in an atrial fibrillation clinic. Each phase was 1 year long. The primary outcome was the rate of new oral anticoagulation prescription at ED discharge for patients who were oral anticoagulation eligible and not receiving oral anticoagulation at presentation. RESULTS: A total of 631 patients were included. Mean age was 69 years (SD 14 years), 47.4% were women, and 69.6% of patients had a CHADS2 score greater than or equal to 1. The rate of new oral anticoagulation prescription in phase 1 was 15.8% compared with 54.1% and 47.2%, in phases 2 and 3, respectively. After multivariable adjustment, the odds ratio for new oral anticoagulation prescription was 8.03 (95% confidence interval 3.52 to 18.29) for phase 3 versus 1. The 6-month rate of oral anticoagulation use was numerically but not significantly higher in phase 3 compared with phase 2 (71.6% versus 79.4%; adjusted odds ratio 2.30; 95% confidence interval 0.89 to 5.96). The rate of major bleeding at 6 months was 0%, 0.8%, and 1% in phases 1, 2, and 3, respectively. CONCLUSION: An oral anticoagulation prescription tool was associated with an increase in new oral anticoagulation prescription in the ED, irrespective of whether an atrial fibrillation clinic follow-up was scheduled. The use of an atrial fibrillation clinic was associated with a trend to a higher rate of oral anticoagulation at 6-month follow-up.
Authors: Clare L Atzema; Cynthia A Jackevicius; Alice Chong; Paul Dorian; Noah M Ivers; Ratika Parkash; Peter C Austin Journal: CMAJ Date: 2019-12-09 Impact factor: 8.262
Authors: Oriol Yuguero; Irene Cabello; María Arranz; Jorge-Alexis Guzman; Anna Moreno; Paloma Frances; Julia Santos; Anna Esquerrà; Alvaro Zarauza; Josep-Maria Mòdol; Javier Jacob Journal: Intern Emerg Med Date: 2021-10-22 Impact factor: 3.397
Authors: Linda S B Johnson; Jonas Oldgren; Tyler W Barrett; Candace D McNaughton; Jorge A Wong; William F McIntyre; Clifford L Freeman; Laura Murphy; Gunnar Engström; Michael Ezekowitz; Stuart J Connolly; Lizhen Xu; Juliet Nakamya; David Conen; Shrikant I Bangdiwala; Salim Yusuf; Jeff S Healey Journal: J Am Heart Assoc Date: 2021-09-13 Impact factor: 5.501