• Blanca Coll-Vinent, Alfonso Martín, Francisco Malagón, Coral Suero, Juan Sánchez, Mercedes Varona, Manuel Cancio, Susana Sánchez, Eugeni Montull, Carmen Del Arco, and HERMES-AF Investigators.
• Arrhythmia Division, Spanish Society of Emergency Medicine, Madrid, Spain; Emergency Department, Unitat de Fibrillació Auricular, Hospital Clínic, Barcelona, and Grup de Recerca "Urgències: processos i patologies," IDIBAPS, Barcelona, Spain. Electronic address: bcvinent@clinic.cat.
• Ann Emerg Med. 2015 Jan 1; 65 (1): 1-12.

Study ObjectiveWe determine the prevalence of stroke prophylaxis prescription in emergency department (ED) patients with atrial fibrillation and the factors associated with a lack of prescription of anticoagulation in high-risk patients without contraindications.MethodsThis was a multicenter, observational, cross-sectional study with prospective standardized data collection carried out in 124 Spanish EDs. Clinical variables, risk factors for stroke, type of prophylaxis prescribed, and reasons for not prescribing anticoagulation in high-risk patients (congestive heart failure/left ventricular dysfunction, hypertension, age >75 years, diabetes and previous stroke/transient ischemic attack/systemic embolism [CHADS2] score ≥2 and the congestive heart failure/left ventricular dysfunction, hypertension, age >75 years, diabetes, previous stroke/transient ischemic attack/systemic embolism, vascular disease age 65 to 74 years and sex category [CHA2DS2-VASc] score ≥2) without contraindications were collected.ResultsOf 3,276 patients enrolled, 71.5% were at high risk according to CHADS2; 89.7% according to CHA2DS2-VASc. At discharge from the ED, 2,255 patients (68.8%) were receiving anticoagulants, 1,691 of whom (75%) were high-risk patients. Of the 1,931 patients discharged home, anticoagulation was prescribed for 384 patients (19.9%) de novo and for 932 patients (48.3%) previously receiving anticoagulation. The main reasons for not prescribing anticoagulation to eligible patients were considering antiplatelet therapy as adequate prophylaxis (33.1%), advanced age (15%), and considering stroke risk as low (8.3%). Advanced age (odds ratio 0.46; 95% confidence interval 0.30 to 0.69) and female sex (odds ratio 0.50; 95% confidence interval 0.36 to 0.71) were significantly associated with the lack of prescription of anticoagulation to eligible patients.ConclusionIn Spain, most patients with atrial fibrillation treated in EDs who do not receive anticoagulation are at high risk of stroke, with relevant differences with regard to the risk stratification scheme used. Anticoagulation is underused, mainly because the risk of stroke is underestimated by the treating physicians and the benefits of antiplatelets are overrated, principally in female patients and the elderly. Efforts to increase the prescription of anticoagulation in these patients appear warranted.Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

24 keywords...

hide…