Key result
Non-English language (28% vs 10%; P=.03) and leaving against medical advice (36% vs 14%; P=.04) were significantly associated with failure to initiate anticoagulation in ED patients with new AF.
Why the study?
Factors associated with anticoagulation initiation after a new atrial fibrillation diagnosis in the emergency department were explored, hypothesizing that minority race and non-English language preference associate with non-initiation.
What factors are associated with anticoagulation initiation in adults with new-onset atrial fibrillation discharged from the emergency department?
Cohort (n=88)
No
What factors are associated with anticoagulation initiation in adults with new-onset atrial fibrillation discharged from the emergency department?
In patients with new-onset atrial fibrillation discharged from the emergency department, cardiology consultation and higher CHA2DS2-VASc scores were associated with anticoagulation initiation, while non-English language preference and leaving against medical advice were barriers.
Factors associated with AC initiation after ED AF diagnosis remain unclear; leaves open optimal discharge practices pending prospective data.
Objective: To explore factors associated with anticoagulation (AC) initiation after atrial fibrillation (AF) diagnosis.Design: Retrospective cohort study.Setting: Urban medical center.Patients: Adults with emergency department (ED) diagnosis of new onset AF from 1/1/2017-1/1/2020 discharged home.Methods: We compared patients initiated on AC, our primary outcome, to those not initiated on AC. Stroke, major bleeding, and AC initiation within 1 year of visit were secondary outcomes. We hypothesized that minority race and non-English language preference are associated with failure to initiate AC.Results: Of 111 patients with AF, 88 met inclusion criteria. Mean age was 65 (SD 15); 47 (53%) were women. 49 (56%) patients were initiated on AC. Age (61 vs 68 years; P=.02), non-English language (28% vs 10%; P=.03), leaving ED against medical advice (AMA) (36% vs 14%; P=.04), and CHA2DS2- VASc score of 1 (41% vs 6%; P<=.001) were associated with no AC initiation. There were no associations between patient-reported race/ethnicity and AC. Cardiology consultation (83.67% vs 30.78%; P<.0001) and higher median CHA2DS2-VASc score (3[2-4]) vs. 2[1-4]; P=.047) were associated with AC. Of 73 patients with follow-up data at 1 year, 2 (8%) not initiated on AC had strokes, 2 (4%) initiated on AC had major bleeds, and 15 (62.5%) not initiated on AC in the ED subsequently were initiated on AC.Conclusion: More than half of ED patients with new AF eligible for AC were initiated on it. Work to improve AC utilization among patients with new AF who left AMA from ED and those who prefer to communicate in a non-English language may be warranted. Ethn Dis. 2022;32(4):325-332; doi:10.18865/ed.32.4.325
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Seiden et al. (2022) conducted a cohort in New onset atrial fibrillation (n=88). Patient demographic and clinical factors (e.g., language, discharge status) vs. Reference patient factors was evaluated on Anticoagulation initiation. Non-English language (28% vs 10%; P=.03) and leaving against medical advice (36% vs 14%; P=.04) were significantly associated with failure to initiate anticoagulation in ED patients with new AF.
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