Introduction: Oral anticoagulation (OAC) is known to reduce stroke risk by 60–80% in patients with Atrial Fibrillation (AF), however, only 50% of eligible patients receive OAC. While many AF patients present to the ED, few are offered OAC. This represents a significant gap in AF care.
Methods: This was a multi-centre, pragmatic, three-phase before-after study, in three Canadian provinces. Patients with documented nonvalvular AF who presented to the ED and were discharged home were included. Phase one encompassed a retrospective chart review to establish baseline practice; Phase two was a low-intensity intervention involving a simple OAC-prescription tool plus educational intervention; Phase three incorporated the low-intensity intervention but added follow-up in an AF clinic. Focus groups were undertaken with ED physicians to examine barriers and facilitators to OAC prescription and interviews with patients were conducted to determine satisfaction with the education intervention.
Results: A total of 632 patients were included from three provinces. The prescription of new OAC to eligible patients was 15.8% in Phase one, as compared to 54% and 47% in Phases two and three. Despite good uptake, barriers to OAC prescription were identified and included concerns about professional risk and safety. Patients had mixed perspectives of the educational intervention but recognized the need for ongoing education.
Conclusions/implications: A simple OAC-prescription tool was associated with an increase in new OAC prescription in the ED for eligible patients with AF. Changes in ED-based OAC prescribing practices could lead to improved stroke prevention but initiatives to promote a safe prescribing culture and patient education may further optimise OAC uptake.
