Prescribing anticoagulants in the ED for atrial fibrillation increases long-term use by 30%

09/12/2019

Patients prescribed anticoagulants after a diagnosis of atrial fibrillation in the emergency department are more likely to continue long-term use of medications to treat the condition, according to researchers at ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues.

"In this multicentre study in Ontario, Canada, providing an oral anticoagulant prescription in the emergency department to patients with atrial fibrillation who were older than 65 years was associated with a marked increase in long-term use of this therapy," writes Dr. Clare Atzema, a senior scientist with ICES and the Division of Emergency Medicine, University of Toronto, with coauthors.

More than 33 million people around the world have atrial fibrillation, that is, an irregular heart beat that is associated with a fivefold increased risk of stroke as well as other cardiac issues. Use of oral anticoagulants can decrease stroke risk by 60 per cent.

Usual practice is to refer patients seen in the emergency department for atrial fibrillation to primary care or a cardiologist for anticoagulant prescription and follow-up.

In this study, published today in the CMAJ, performed at 15 centres in Ontario, researchers found that if an oral anticoagulant was prescribed in the emergency department to patients aged 65 years or older who were not at high risk of bleeding, there was a 31 per cent absolute increase in the tendency to fill the prescription at 6 months, compared with referral to the patient’s physician to consider starting the medication.

"Physicians working in the emergency department should consider initiating oral anticoagulants in similar patients [patients with atrial fibrillation] who are being discharged home, because this action is associated with improved use of stroke prevention long after the patient leaves the emergency department," the authors recommend.

The study “Prescribing of oral anticoagulants in the emergency department and subsequent long-term use by older adults with atrial fibrillation,” was published in the CMAJ.

Author block: Clare L. Atzema MD MSc, Cynthia A. Jackevicius PharmD MSc, Alice Chong BSc, Paul Dorian MD MSc, Noah M. Ivers MD PhD, Ratika Parkash MD MSc, Peter C. Austin PhD.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario.