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Oral anticoagulation for patients with atrial fibrillation in the ED: RE-LY AF registry analysis

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Abstract

Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF). We sought to determine predictors of OAC initiation in AF patients presenting to the emergency department (ED). Secondary analysis of the RE-LY AF registry which enrolled individuals from 47 countries between 2007 and 2011 who presented to an ED with AF and followed them for 1 year. A total of 4149 patients with AF as their primary diagnosis who were not already taking OAC and had a CHA2DS2-VASc ≥ 1 for men or ≥ 2 for women were included in this analysis. Of these individuals, 26.8% were started on OAC (99.2% vitamin K antagonists) in the ED and 29.8% were using OAC one year later. Factors associated with initiating OAC in the ED included: specialist consultation (relative risk [RR] 1.84, 95%CI 1.44–2.36), rheumatic heart disease (RR 1.60, 95%CI 1.29–1.99), persistence of AF at ED discharge (RR 1.33, 95%CI 1.18–1.50), diabetes mellitus (RR 1.32, 95%CI 1.19–1.47), and hospital admission (RR 1.30, 95%CI 1.14–1.47). Heart failure (RR 0.83, 95%CI 0.74–0.94), antiplatelet agents (RR 0.77, 95%CI 0.69–0.84), and dementia (RR 0.61, 95%CI 0.40–0.94) were inversely associated with OAC initiation. Patients taking OAC when they left the ED were more likely using OAC at 1-year (RR 2.81, 95%CI 2.55–3.09) and had lower rates of death (RR 0.55, 95%CI 0.38–0.79) and stroke (RR 0.59, 95%CI 0.37–0.96). In patients with AF presenting to the ED, prompt initiation of OAC and specialist involvement are associated with a greater use of OAC 1 year later and may result in improved clinical outcomes.

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Data availability

All data from the RE-LY AF registry are kept securely at the Population Health Research Institute in Hamilton, Ontario. Specific data may be provided upon request.

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Acknowledgements

W.F. McIntyre is supported by personnel awards from the Canadian Stroke Prevention Intervention Network and the Canadian Institutes for Health Research. C.L. Atzema and R.P. Whitlock are supported by personnel awards from the Heart and Stroke Foundation. J.S. Healey holds the Population Health Institute Chair in Cardiology Research. E.P. Belley-Côté is supported by the E.J. Moran Campbell McMaster University Department of Medicine career award. No funding was directed toward this project, but the RE-LY AF registry was supported by a Grant from Boehringer-Ingelheim.

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Author notes

  1. Jeff S. Healey

    Present address: Population Health Research Institute, Hamilton, ON, Canada

Authors and Affiliations

  1. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Pablo A. Mendoza, William F. McIntyre, Richard P. Whitlock & Jeff S. Healey

  2. Population Health Research Institute, Hamilton, ON, Canada

    Pablo A. Mendoza, William F. McIntyre, Emilie P. Belley-Côté, Jia Wang, Alexander P. Benz & Richard P. Whitlock

  3. Department of Medicine, McMaster University, Hamilton, ON, Canada

    William F. McIntyre, Emilie P. Belley-Côté & Jeff S. Healey

  4. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Richard P. Whitlock

  5. Department of Medicine, Dalhousie University, Halifax, NS, Canada

    Ratika Parkash

  6. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Clare L. Atzema

  7. Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden

    Jonas Oldgren

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Consortia

the RE-LY AF Registry Investigators

Contributions

PAM contributed to the concept and design, analysis, interpretation of the data and writing of the manuscript. WFM, EPBC, JW and JSH contributed to the concept and design, analysis, interpretation of the data and writing of the manuscript. RP, CLA, APB, JO, and RPW contributed to the interpretation of the data and writing of the manuscript. All authors approved of final version.

Corresponding author

Correspondence to Jeff S. Healey.

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Conflict of interest

Jeff Healey reports research grants and speaking fees from Boehringer-Ingelheim, Bayer, BMS/Pfizer and Servier.

Ethical approval

In the RE-LY AF registry, ethical committees approved the study at participating centers in 47 countries, and sites collected clinical data through interviews with patients, review of medical records and contact with the treating physician.

Informed consent

Informed consent was obtained from all individual participants included in the RE-LY AF registry.

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Mendoza, P.A., McIntyre, W.F., Belley-Côté, E.P. et al. Oral anticoagulation for patients with atrial fibrillation in the ED: RE-LY AF registry analysis. J Thromb Thrombolysis 53, 74–82 (2022). https://doi.org/10.1007/s11239-021-02530-3

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