Abstract TMP69: The Use of Oral Anticoagulants in Patients With Atrial Fibrillation in the Emergency Department

Abstract

Background: Atrial Fibrillation (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 oral anticoagulants (OACs). Guidelines for Primary Prevention of Stroke recommend the emergency department (ED) as an important location for physicians to identify patients with AF and start them on OACs. 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. CHA 2 D 2 -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 CHA 2 D 2 -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 (CHA 2 D 2 -VASc score ≥ 2) 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) Direct OACs were more commonly prescribed over Warfarin across all three groups. (92.3% in ED, 88.5% in observation, 82.5% in inpatient). 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.