- After treating patients in the emergency department (ED) for Afib, emergency physicians should consider initiating a prescription for oral anticoagulants.
- Patients are much likelier to be taking these medications months later if a prescription is issued in the ED.
Why this matters
- Afib rates are rising worldwide.
- After an Afib-related ED encounter, about two-thirds of Canadian patients are discharged home.
- Primary care providers and cardiologists typically decide whether to start oral anticoagulants to prevent stroke.
- Not enough people with Afib who would potentially benefit from these drugs are taking them.
- 18.9% (402) had oral anticoagulant prescription issued in ED, 73.6% of which were written by emergency physician rather than consultant.
- Proportions filling prescription at 6 months:
- After ED prescription: 67.8%.
- Without ED prescription: 37.2%.
- Absolute risk increase, 30.6%.
- Number needed to treat: 3.
- Death, stroke, bleeding rates similar between groups.
- 15-hospital retrospective cohort study of elderly patients being discharged from EDs in Ontario, Canada, with primary diagnosis of Afib/Aflutter, 2009-2014 (n=2132).
- All were eligible for oral anticoagulants.
- Authors compared outcomes in those with vs without ED-initiated prescription.
- Outcome: filled prescription 6 months later.
- Funding: Canadian Institutes for Health Research.
- Low event rates.