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Emergency Department capacity to initiate thromboprophylaxis in patients with atrial fibrillation and thrombotic risk after discharge: URGFAICS cohort analysis

Abstract

Atrial fibrillation (AF) is the most prevalent heart rhythm disorder in the general population. Stroke prevention is one of the leading management objectives in the treatment of AF patients. The variables associated with the non-initiation of thromboprophylaxis in patients with thrombotic risk consulting for an episode of AF in Emergency Departments (ED) were investigated. This was a multipurpose, analytical, non-interventionist, multicenter Spanish study with a prospective 30-day follow-up. All patients ≥ 18 years of age consulting to the ED for the casual finding of AF in an electrocardiogram (ECG) performed 12 h prior to the consultation or with symptoms related to AF were enrolled from September 1, 2016 to February 28, 2017. Patients not previously received thromboprophylaxis were selected. Multivariate analysis was performed to calculate the odds ratio (OR) and the 95% confidence interval (CI). A total of 634 patients, not received thromboprophylaxis and at high thrombotic risk, were included. Of these, 251 (39.6%) did not receive thromboprophylaxis at ED discharge. In the multivariate analysis, non-initiation of anticoagulation at discharge from the ED was mostly related to cognitive impairment (OR 3.95; (95% CI 2.02–7.72), cancer history (OR 2.12; (95%CI 1.18–3.81), AF duration < 48 h (OR 2.49; (95% CI 1.48–4.21) and patients with re-establishment of sinus rhythm (OR 3.65; (95% CI 1.47–9.06). Reinforcement of the use of CHA2DS2-VASC as a stroke risk scale and empowerment of ED physicians is a must to improve this gap in care.

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Acknowledgements

Additional authors and members of the URGFAICS Research Group: Dr Xavier Ichart Tomas (Hospital Arnau de Vilanova); Dr Jesús Galvez Mora (Hospital Universitari Joan XXIII); Dr Adrià Steinherr and Dr Neus Robert (Hospital Universitari Germans Trias i Pujol de Badalona); Dr Genis Camprubí (Hospital Universitari de Bellvitge); Dr Loreto Espuis Albas, Dr Javier Del Castillo Nos, Dr Àngel Sierra Moreno and Dr Cristina Herranz Martínez (Hospital de Viladecans).

Funding

This study had no financial support.

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Authors

Contributions

OY, IC and JJ, conceived and designed the study. JJ coordinated the study. All authors supervised the recruitment of patients and management of data. All authors supervised the conduct of the study and data collection. JJ and IC performed statistical analysis. IC, OY and JJ drafted the manuscript and all authors contributed to its revision and approved the final version. IC, OY and JJ take responsibility for the paper as a whole.

Corresponding author

Correspondence to Irene Cabello.

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Conflict of interest

The authors (OY, IC, MA, JG, AM, PF, JS, AE, AZ, JMM and JJ) declare no conflict of interest.

Ethical approval

The study was approved by the Clinical Research Ethics Committee of Hospital Universitari de Bellvitge, Barcelona, Spain (reference number PR354/16).

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data.

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Yuguero, O., Cabello, I., Arranz, M. et al. Emergency Department capacity to initiate thromboprophylaxis in patients with atrial fibrillation and thrombotic risk after discharge: URGFAICS cohort analysis. Intern Emerg Med (2021). https://doi.org/10.1007/s11739-021-02864-z

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Keywords

  • Atrial fibrillation
  • Stroke
  • Thromboprophylaxis
  • Emergency medicine