Abstract Details

Title The Use Of Oral Anticoagulants In Patients With Atrial Fibrillation In The Emergency Department

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S35 - Stroke Prevention Strategies (1:11 PM-1:22 PM)

Poster/Presentation
Number 002

Background AF is the leading cause of embolic stroke and is associated with a 5-fold increased risk of stroke. Currently, less than 50% of high-risk patients are receiving a prescription for OACs. Guidelines for Primary Prevention of Stroke recommend the ED as an important location for physicians to identify patients with AF and start them on OACs.

Objective To examine the prevalence of oral anticoagulant (OAC) prescription for patients with atrial fibrillation (AF) in the emergency department (ED).

Design/Methods A retrospective review was completed of AF patients in the ED from 2014-2018 at a large health system. The prevalence of OAC prescription was identified in three different cohorts: 1) patients discharged from the ED, 2) those admitted under observation status and discharged within 48 hours, and 3) those admitted to inpatient. CHA₂DS₂-VASc scores were calculated and risk factors were reviewed.

Results We identified 438 patients: 106 in the ED cohort, 132 in the observation cohort and 200 in the inpatient cohort. The average age was 63.1. 77.9% had hypertension and 46.35% were women. The average CHA₂DS₂-VASc score was 2.45 in the ED cohort, 2.56 in the observation cohort and 3.35 in the inpatient cohort. ED physicians addressed AF in 77% of the ED cohort. Out of the high-risk patients (CHA₂DS₂-VASc score > 1) discharged from the ED, 17% were newly prescribed an OAC compared to 74% of patients who were admitted under observation status and 78% of patients admitted to inpatient. (7/40 [17.5%] vs 39/53 [73.6%]; p<.0001 and 83/107 [77.6%]; p<.0001)

Conclusions Patients with AF are more likely to be prescribed an OAC if admitted to inpatient or under observation status compared to the ED. There were many missed opportunities in the ED to start patients on OACs. Further studies should identify barriers to OAC prescription in the ED to implement better practice strategies.

Authors/Disclosures
Hope Hua, MD (Work) PRESENTER	Dr. Hua has nothing to disclose.
Nicole B. Sur, MD (University of Miami)	Dr. Sur has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke. The institution of Dr. Sur has received research support from Florida Stroke Registry. The institution of Dr. Sur has received research support from Miami CTSI & NIH/NINDS.
	No disclosure on file
Sai P. Polineni, MD	Dr. Polineni has nothing to disclose.
Jaydeep Sharma	No disclosure on file
Seemant Chaturvedi, MD, FAHA, FAAN (University of Maryland)	Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra Zeneca. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Calgary. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Ramar & Paradiso. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Cole, Scott, Kissane. The institution of Dr. Chaturvedi has received research support from NINDS.

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