Oral Anticoagulation Therapy in Atrial Fibrillation Patients Managed in the Emergency Department Compared to Cardiology Outpatient: Opportunities for Improved Outcomes

Geetanjali Rangnekar, Celine Gallagher, Geoffrey R. Wong, Simon Rocheleau, Anthony G. Brooks, Jeroen M.L. Hendriks, Melissa E. Middeldorp, Adrian D. Elliott, Rajiv Mahajan, Prashanthan Sanders, Dennis H. Lau

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Abstract

Introduction: Recent registry data suggests oral anticoagulation (OAC) usage remains suboptimal in atrial fibrillation (AF) patients. The aim of our study was to determine if rates of appropriate use of OAC in individuals with AF differs between the emergency department (ED) and cardiac outpatient clinic (CO). Methods: This was a retrospective study of consecutive AF patients over a 12-month period. Data from clinical records, discharge summaries and outpatient letters were independently reviewed by two investigators. Appropriateness of OAC was assessed according to the CHA 2 DS 2 -VASc score. Results: Of 455 unique ED presentations with AF as a primary diagnosis, 115 patients who were treated and discharged from the ED were included. These were compared to 259 consecutively managed AF patients from the CO. Inappropriate OAC was significantly higher in the ED compared to the CO group (65 vs. 18%, p < 0.001). Treatment in the ED was a significant multivariate predictor of inappropriate OAC (odds ratio 8.2 [4.8–17.7], p < 0.001). Conclusions: This patient level data highlights that significant opportunity exists to improve disparities in the use of guideline adherent therapy in the ED compared to CO. There is an urgent need for protocol-driven treatment in the ED or streamlined early follow-up in a specialised AF clinic to address this treatment gap.

Original languageEnglish
Pages (from-to)e43-e46
Number of pages4
JournalHeart Lung and Circulation
Volume28
Issue number4
DOIs
Publication statusPublished - Apr 2019
Externally publishedYes

Keywords

  • Atrial fibrillation
  • Emergency department
  • Oral anticoagulation
  • Specialist care
  • Stroke prevention

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    Rangnekar, G., Gallagher, C., Wong, G. R., Rocheleau, S., Brooks, A. G., Hendriks, J. M. L., Middeldorp, M. E., Elliott, A. D., Mahajan, R., Sanders, P., & Lau, D. H. (2019). Oral Anticoagulation Therapy in Atrial Fibrillation Patients Managed in the Emergency Department Compared to Cardiology Outpatient: Opportunities for Improved Outcomes. Heart Lung and Circulation, 28(4), e43-e46. https://doi.org/10.1016/j.hlc.2018.03.024