Thromboprophylaxis for patients with high-risk atrial fibrillation and flutter discharged from the emergency department

David R. Vinson, E. Margaret Warton, Dustin G. Mark, Dustin W. Ballard, Mary E. Reed, Uli K. Chettipally, Nimmie Singh, Sean Z. Bouvet, Bory Kea, Patricia C. Ramos, David S. Glaser, Alan S. Go

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction: 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). Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)346-360
Number of pages15
JournalWestern Journal of Emergency Medicine
Volume19
Issue number2
DOIs
StatePublished - Mar 1 2018

Fingerprint

Atrial Flutter
Atrial Fibrillation
Hospital Emergency Service
Anticoagulants
Stroke
Odds Ratio
Confidence Intervals
Emergency Medical Services
Cardiology
Decision Making
Emergencies
Outpatients
Referral and Consultation
Prospective Studies
Hemorrhage
Physicians
Population

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Vinson, D. R., Warton, E. M., Mark, D. G., Ballard, D. W., Reed, M. E., Chettipally, U. K., ... Go, A. S. (2018). Thromboprophylaxis for patients with high-risk atrial fibrillation and flutter discharged from the emergency department. Western Journal of Emergency Medicine, 19(2), 346-360. https://doi.org/10.5811/westjem.2017.9.35671

Thromboprophylaxis for patients with high-risk atrial fibrillation and flutter discharged from the emergency department. / Vinson, David R.; Warton, E. Margaret; Mark, Dustin G.; Ballard, Dustin W.; Reed, Mary E.; Chettipally, Uli K.; Singh, Nimmie; Bouvet, Sean Z.; Kea, Bory; Ramos, Patricia C.; Glaser, David S.; Go, Alan S.

In: Western Journal of Emergency Medicine, Vol. 19, No. 2, 01.03.2018, p. 346-360.

Research output: Contribution to journalArticle

Vinson, DR, Warton, EM, Mark, DG, Ballard, DW, Reed, ME, Chettipally, UK, Singh, N, Bouvet, SZ, Kea, B, Ramos, PC, Glaser, DS & Go, AS 2018, 'Thromboprophylaxis for patients with high-risk atrial fibrillation and flutter discharged from the emergency department', Western Journal of Emergency Medicine, vol. 19, no. 2, pp. 346-360. https://doi.org/10.5811/westjem.2017.9.35671
Vinson, David R. ; Warton, E. Margaret ; Mark, Dustin G. ; Ballard, Dustin W. ; Reed, Mary E. ; Chettipally, Uli K. ; Singh, Nimmie ; Bouvet, Sean Z. ; Kea, Bory ; Ramos, Patricia C. ; Glaser, David S. ; Go, Alan S. / Thromboprophylaxis for patients with high-risk atrial fibrillation and flutter discharged from the emergency department. In: Western Journal of Emergency Medicine. 2018 ; Vol. 19, No. 2. pp. 346-360.
@article{02d29bdbce7d413397cee085b4eb34f7,
title = "Thromboprophylaxis for patients with high-risk atrial fibrillation and flutter discharged from the emergency department",
abstract = "Introduction: 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). Methods: 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. Results: 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. Conclusion: 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.",
author = "Vinson, {David R.} and Warton, {E. Margaret} and Mark, {Dustin G.} and Ballard, {Dustin W.} and Reed, {Mary E.} and Chettipally, {Uli K.} and Nimmie Singh and Bouvet, {Sean Z.} and Bory Kea and Ramos, {Patricia C.} and Glaser, {David S.} and Go, {Alan S.}",
year = "2018",
month = "3",
day = "1",
doi = "10.5811/westjem.2017.9.35671",
language = "English (US)",
volume = "19",
pages = "346--360",
journal = "Western Journal of Emergency Medicine",
issn = "1936-900X",
publisher = "University of California",
number = "2",

}

TY - JOUR

T1 - Thromboprophylaxis for patients with high-risk atrial fibrillation and flutter discharged from the emergency department

AU - Vinson, David R.

AU - Warton, E. Margaret

AU - Mark, Dustin G.

AU - Ballard, Dustin W.

AU - Reed, Mary E.

AU - Chettipally, Uli K.

AU - Singh, Nimmie

AU - Bouvet, Sean Z.

AU - Kea, Bory

AU - Ramos, Patricia C.

AU - Glaser, David S.

AU - Go, Alan S.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Introduction: 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). Methods: 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. Results: 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. Conclusion: 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.

AB - Introduction: 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). Methods: 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. Results: 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. Conclusion: 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.

UR - http://www.scopus.com/inward/record.url?scp=85043312079&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85043312079&partnerID=8YFLogxK

U2 - 10.5811/westjem.2017.9.35671

DO - 10.5811/westjem.2017.9.35671

M3 - Article

C2 - 29560065

AN - SCOPUS:85043312079

VL - 19

SP - 346

EP - 360

JO - Western Journal of Emergency Medicine

JF - Western Journal of Emergency Medicine

SN - 1936-900X

IS - 2

ER -