Abstract Details

Title Emergency Medicine Physicians’ Perceptions of Initiating Anticoagulants in the Emergency Department for Patients with Atrial Fibrillation

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S53 - Stroke Prevention (4:30 PM-4:42 PM)

Poster/Presentation
Number 006

Objective To obtain opinions of Emergency Medicine physicians and residents on initiating oral anticoagulants (OACs) in patients seen in the Emergency Department (ED) with atrial fibrillation (AF).

Background 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. Currently, less than 50% of high-risk patients are receiving a prescription for OACs. A recent retrospective review found that patients with AF admitted for observation or to an inpatient service were at least 4 times more likely to be discharged with an OAC prescription compared to those discharged directly from the ED.

Design/Methods A 14-item survey consisting of single-, multi-answer and open-ended questions was distributed to ED physicians and residents to assess their opinions of initiating OACs in the ED and knowledge of the CHA₂DS₂-VASc score. Nearly all physicians worked at the Jackson Health System in Miami, FL.

Results 52 physicians responded to the survey: 30 attending physicians and 22 residents. 40% of responders were female. 98% agreed that the ED is an important location to identify patients with new-onset AF and 86.5% agreed the ED was an important location to initiate anticoagulation depending on co-morbidities. 77% believed that the ED physician along with the Primary Care Provider (PCP)/ Cardiologist/ Neurologist had a role in starting a patient with AF on an OAC. 44% had never started a patient in the ED on a new OAC prescription upon discharge. The most common reasons for not initiating OAC for an AF patient included not wanting to be held responsible for a bleeding event (37%) and deferring responsibility of initiating OAC to the PCP/ Cardiologist/ Neurologist (37%).

Conclusions

Emergency Medicine physicians seem to support initiating OACs in the ED for patients with AF; however, major discrepancies exist between their intentions and actual practice.

Authors/Disclosures
Hope Hua, MD (Work) PRESENTER	Dr. Hua 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.
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.

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