A multi-hospital analysis of predictors of oral anticoagulation prescriptions for patients with actionable atrial fibrillation who attend the emergency department.

Acute cardiac care Pub Date : 2016-12-01 Epub Date: 2017-11-29 DOI:10.1080/17482941.2017.1406954
Joel A Scott-Herridge, Colette M Seifer, Ron Steigerwald, Glen Drobot, William F McIntyre
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引用次数: 4

Abstract

Atrial fibrillation (AF) is the most common arrhythmia and is associated with an increase in the risk of ischemic stroke. The risk of stroke can be significantly decreased by oral anticoagulation (OAC). Our objective was to characterize the filling of OAC prescriptions for patients with actionable AF (new or existing AF with an indication for OAC but not prescribed) and determine the prevalence and predictors of guideline-appropriate therapy at 30 days. This is a multi-hospital, retrospective cohort study of patients who visited the Emergency Department (ED) and had a discharge diagnosis of AF. Patient records were examined to identify demographics, risk factors, and prescription data. Predictors of filling a prescription at 30 days were analyzed. 788 patients with AF were reviewed. 257 patients had actionable AF. Forty one percent (104) had newly diagnosed AF. The mean CHADS2 score was 2 ± 1. At 30 days after discharge, 25.7% of patients filled a prescription for OAC therapy. Large numbers of patients attending the ED have actionable AF, but rates of guideline-directed OAC at thirty days are low. Only a prescription written by the ED physician (OR 9.89) and documentation of stroke risk stratification in the patients' chart (OR 4.09) were associated with the primary outcome.

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多家医院对急诊科可操作心房颤动患者口服抗凝处方预测因素的分析
心房颤动(AF)是最常见的心律失常,与缺血性中风的风险增加有关。口服抗凝剂(OAC)可显著降低卒中风险。我们的目的是表征可行动性房颤(新的或现有的房颤有OAC指征但未开处方)患者的OAC处方的填写情况,并确定30天内指南适当治疗的患病率和预测因素。这是一项多家医院的回顾性队列研究,研究对象是到急诊科(ED)就诊并出院诊断为房颤的患者。研究人员检查了患者记录,以确定人口统计学、危险因素和处方数据。分析了30天内配药的预测因素。回顾了788例房颤患者。257例患者为可行动性房颤,41%(104例)为新诊断房颤。CHADS2平均评分为2±1。出院后30天,25.7%的患者开处方接受OAC治疗。大量急诊科患者有可操作的房颤,但指南指导的30天房颤发生率很低。只有急诊科医生开具的处方(OR为9.89)和患者病历中卒中风险分层的记录(OR为4.09)与主要结局相关。
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