Afib: initiating oral anticoagulant in the emergency department improves adherence

Takeaway

• 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.

Key results

• 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.

Study design

• 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.

Limitations

• Low event rates.