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{ "pk": 11066, "title": "Thromboprophylaxis for Patients with High-risk Atrial Fibrillation and Flutter Discharged from the Emergency Department", "subtitle": null, "abstract": "Introduction:\n Many patients with atrial fibrillation or atrial flutter (AF/FL) who are high risk for ischemic stroke are not receiving evidence-based thromboprophylaxis. We examined anticoagulant prescribing within 30 days of receiving dysrhythmia care for non-valvular AF/FL in the emergency department (ED). \nMethods:\n This prospective study included non-anticoagulated adults at high risk for ischemic stroke (ATRIA score ≥7) who received emergency AF/FL care and were discharged home from seven community EDs between May 2011 and August 2012. We characterized oral anticoagulant prescribing patterns and identified predictors of receiving anticoagulants within 30 days of the index ED visit. We also describe documented reasons for withholding anticoagulation.\nResults:\n Of 312 eligible patients, 128 (41.0%) were prescribed anticoagulation at ED discharge or within 30 days. Independent predictors of anticoagulation included age (adjusted odds ratio [aOR] 0.89 per year, 95% confidence interval [CI] 0.82-0.96); ED cardiology consultation (aOR 1.89, 95% CI [1.10-3.23]); and failure of sinus restoration by time of ED discharge (aOR 2.65, 95% CI [1.35-5.21]). Reasons for withholding anticoagulation at ED discharge were documented in 139 of 227 cases (61.2%), the most common of which were deferring the shared decision-making process to the patient’s outpatient provider, perceived bleeding risk, patient refusal, and restoration of sinus rhythm. \nConclusion:\n Approximately 40% of non-anticoagulated AF/FL patients at high risk for stroke who presented for emergency dysrhythmia care were prescribed anticoagulation within 30 days. Physicians were less likely to anticoagulate older patients and those with ED sinus restoration. Opportunities exist to improve rates of thromboprophylaxis in this high-risk population.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Anticoagulants/therapeutic use" }, { "word": "Atrial Fibrillation/complications" }, { "word": "Atrial Flutter/complications" }, { "word": "emergency service, hospital" }, { "word": "risk assessment" }, { "word": "Stroke/prevention &" }, { "word": "Control" } ], "section": "Patient Safety", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/7hn511dt", "frozenauthors": [ { "first_name": "David", "middle_name": "R.", "last_name": "Vinson", "name_suffix": "", "institution": "The Permanente Medical Group, Oakland, California\nKaiser Permanente, Division of Research, Oakland, California\nKaiser Permanente Sacramento Medical Center, Department of Emergency Medicine, Sacramento, California", "department": "None" }, { "first_name": "E.", "middle_name": "Margaret", "last_name": "Warton", "name_suffix": "", "institution": "Kaiser Permanente, Division of Research, Oakland, California", "department": "None" }, { "first_name": "Dustin", "middle_name": "G.", "last_name": "Mark", "name_suffix": "", "institution": "The Permanente Medical Group, Oakland, California\nKaiser Permanente, Division of Research, Oakland, California\nKaiser Permanente Oakland Medical Center, Department of Emergency Medicine, Oakland, California", "department": "None" }, { "first_name": "Dustin", "middle_name": "W.", "last_name": "Ballard", "name_suffix": "", "institution": "The Permanente Medical Group, Oakland, California\nKaiser Permanente, Division of Research, Oakland, California\nKaiser Permanente San Rafael Medical Center, Department of Emergency Medicine, San Rafael, California", "department": "None" }, { "first_name": "Mary", "middle_name": "E.", "last_name": "Reed", "name_suffix": "", "institution": "Kaiser Permanente, Division of Research, Oakland, California", "department": "None" }, { "first_name": "Uli", "middle_name": "K.", "last_name": "Chettipally", "name_suffix": "", "institution": "The Permanente Medical Group, Oakland, California\nKaiser Permanente South San Francisco Medical Center, Department of Emergency Medicine, San Francisco, California", "department": "None" }, { "first_name": "Nimmie", "middle_name": "", "last_name": "Singh", "name_suffix": "", "institution": "Mercy Redding Family Practice Residency Program, Redding, California", "department": "None" }, { "first_name": "Sean", "middle_name": "Z.", "last_name": "Bouvet", "name_suffix": "", "institution": "The Permanente Medical Group, Oakland, California\nKaiser Permanente Walnut Creek Medical Center, Department of Emergency Medicine, Walnut Creek, California", "department": "None" }, { "first_name": "Bory", "middle_name": "", "last_name": "Kea", "name_suffix": "", "institution": "Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon", "department": "None" }, { "first_name": "Patricia", "middle_name": "C", "last_name": "Ramos", "name_suffix": "", "institution": "Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon", "department": "None" }, { "first_name": "David", "middle_name": "S.", "last_name": "Glaser", "name_suffix": "", "institution": "Sisters of Charity of Leavenworth St. Joseph Hospital, Department of Emergency Medicine, Denver, Colorado", "department": "None" }, { "first_name": "Alan", "middle_name": "S.", "last_name": "Go", "name_suffix": "", "institution": "The Permanente Medical Group, Oakland, California\nKaiser Permanente, Division of Research, Oakland, California\nUniversity of California, San Francisco, Departments of Epidemiology, Biostatistics, and Medicine, San Francisco, California\nStanford University School of Medicine, Department of Health Research and Policy, Palo Alto, California", "department": "None" } ], "date_submitted": "2017-07-15T01:17:40Z", "date_accepted": "2017-07-15T01:17:40Z", "date_published": "2018-02-12T18:34:30Z", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11066/galley/5960/download/" } ] }