A multi-hospital analysis of predictors of oral anticoagulation prescriptions for patients with actionable atrial fibrillation who attend the emergency department

ABSTRACT

Atrial fibrillation (AF) is the most common arrhythmia and is associated with an increase in the risk of ischemic stroke. The risk of stroke can be significantly decreased by oral anticoagulation (OAC). Our objective was to characterize the filling of OAC prescriptions for patients with actionable AF (new or existing AF with an indication for OAC but not prescribed) and determine the prevalence and predictors of guideline-appropriate therapy at 30 days.

This is a multi-hospital, retrospective cohort study of patients who visited the Emergency Department (ED) and had a discharge diagnosis of AF. Patient records were examined to identify demographics, risk factors, and prescription data. Predictors of filling a prescription at 30 days were analyzed.

788 patients with AF were reviewed. 257 patients had actionable AF. Forty one percent (104) had newly diagnosed AF. The mean CHADS₂ score was 2 ± 1. At 30 days after discharge, 25.7% of patients filled a prescription for OAC therapy.

Large numbers of patients attending the ED have actionable AF, but rates of guideline-directed OAC at thirty days are low. Only a prescription written by the ED physician (OR 9.89) and documentation of stroke risk stratification in the patients’ chart (OR 4.09) were associated with the primary outcome.

KEYWORDS:

• Atrial fibrillation
• anticoagulation
• stroke
• emergency department

Acknowledgments

The authors would like to thank Pina Auriti, Lorna Sasley, Christine Hasse for their assistance with the chart review.

Declaration of interest

There are no conflicts of interest to disclose.

Funding

This study was funded in part by the Grace Hospital Patient Care Research Award. Dr. McIntyre has received fellowship support from the McMaster Cooper Fellowship and the Canadian Stroke Prevention Intervention Network (C-SPIN) Fellowship.

Additional information

Funding

This study was funded in part by the Grace Hospital Patient Care Research Award. Dr. McIntyre has received fellowship support from the McMaster Cooper Fellowship and the Canadian Stroke Prevention Intervention Network (C-SPIN) Fellowship.