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Abstract Details

Starting anticoagulation for new-onset atrial fibrillation in the Emergency Department
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
131
To report rates of anticoagulation (AC) initiation among Emergency Department (ED) patients with new-onset atrial fibrillation (afib) and detail reasons for not prescribing AC to identify targets for improvements in stroke prevention.
New-onset afib is an important risk factor for acute ischemic stroke. AC is recommended as first-line treatment in nearly all cases for primary and secondary stroke prevention. Most patients with new-onset afib found in the ED setting warrant AC, but systems of care and patient work-flows are underdeveloped to facilitate treatment initiation.
We conducted a retrospective, observational cohort study of consecutive adult patients with an ED discharge diagnosis code of afib/atrial flutter from Montefiore Medical Center's four EDs between 1/1/2017 and 1/1/2020. Patients were identified using ICD-10-CM code I48 as the primary discharge diagnosis. Patients were excluded if they were ultimately admitted to the hospital, already taking AC, or diagnosed with afib/flutter prior to index visit. Demographics and pre-specified clinical variables, including reasons for not starting AC, were abstracted from the electronic medical record of included patients. Standard descriptive statistics were used to detail findings.
We identified 111 patients with new-onset afib in the ED who met inclusion criteria. Median age was 61; 45.0% were women. 43.2% of patients were prescribed AC at ED discharge; 55.9% were not. Reasons cited for not prescribing AC in the ED were low CHA2DS2-VASc score (n=23), elopement from the ED (n=15), deferral to outpatient provider (n=12), medical contraindication (n=5), and patient refusal (n=4). A reason was not documented in 4 cases.
In our cohort of patients discharged from the ED with new-onset afib, more than half were not started on AC. There are clear opportunities to reduce ischemic stroke risk among ED patients with new-onset afib; future work targeting ED patients with new-onset afib who elope from the ED may be warranted.
Authors/Disclosures
Johanna Seiden, MD
PRESENTER 		Dr. Seiden has nothing to disclose.
No disclosure on file
Daniel L. Labovitz, MD An immediate family member of Dr. Labovitz has received personal compensation for serving as an employee of Herrick Feinstein.
Ava L. Liberman, MD (Weill Cornell Medicine) Dr. Liberman has nothing to disclose.