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首页> 外文期刊>Canadian Journal of Emergency Medicine >LO05: Rate of prescription of oral anticoagulation in patients presenting with new onset atrial fibrillation/flutter
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LO05: Rate of prescription of oral anticoagulation in patients presenting with new onset atrial fibrillation/flutter

机译：LO05：用新发起心房颤动/颤动的患者口服抗凝术率

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Introduction: Atrial fibrillation (AF) and atrial flutter (AFL) are two common arrhythmias that present to the emergency department (ED) and are a major risk factor for stroke. The 2014 Canadian Cardiovascular Society (CCS) guidelines recommend starting oral anticoagulation (OAC) upon ED discharge for patients with CHADS65 scores of ≥1 to reduce stroke risk. The goal of this study was to identify whether the ED patient population presenting with new onset AF/AFL with CHADS65?≥?1 are appropriately initiated on OAC by ED physicians. Methods: This was a retrospective chart review (Jan-Dec 2017) of ED visits at two academic hospitals in Ontario. The year 2017 was chosen to allow for adequate time from the publishing of the CCS guidelines for uptake into clinical practice. Inclusion criteria: patients with a new diagnosis of AF/AFL who are discharged by ED physicians. Exclusion criteria: patients with a history of AF/AFL, already on OAC, admitted to hospital, presenting with arrhythmia other than AF/AFL, and charts without adequate information to calculate CHADS65 score. Charts were reviewed in detail to assess CHADS65 score, ED physician decision to prescribe OAC, referral rates to outpatient clinics and timing of follow up. Results: A total of 1272 charts were reviewed. 1124 were excluded. 148 charts were identified as patients with new onset AF/AFL presenting to the ED who were discharged by ED physicians. 24/148 (16%) were appropriately prescribed OAC. 124/148 (84%) were not prescribed OAC. Of these 40/124 (32%) were CHADS65 0 while the other 84/124 (67%) were CHADS65?≥?1 who should have been considered for OAC. Further review determined that 78/84 (92%) were referred to outpatient clinics for the decision regarding OAC with the mean (SD) number of days to follow up being 11(±15). Importantly 1/84 (1.2%) returned prior to their scheduled appointment with a stroke. Only 6/84 (7%) had no follow up arranged. Conclusion: Overall, we found that the rate of OAC prescription by ED physicians for patients being discharged with a new diagnosis of AF/AFL with a CHADS65 score ≥1 was 16%. This is despite the CCS 2014 recommendation of starting OAC for all patients with a CHADS65 score ≥1. It appears that ED physicians are continuing to defer the decision to prescribe OAC to outpatient clinics. Further projects can explore barriers to application of the CCS guidelines and create knowledge translation tools.
机译：介绍：心房颤动（AF）和心房颤动（AFL）是向急诊部门（ED）的两种常见心律失常，是中风的主要危险因素。 2014年加拿大心血管社会（CCS）指南建议在ED放电时启动口服抗凝（OAC）≥1的乍得，以减少卒中风险。本研究的目标是识别ED患者群体是否与乍得65？≥？1的新发起AF / AFL呈现出在OAC的OAC上进行适当发起。方法：这是在安大略省两家学院院士的审查审查（2017年1月至2017年12月）。选择了2017年，允许从CCS的出版准则进行适当的时间，以进入临床实践。纳入标准：患者由ED医生排放的AF / AFL的新诊断。排除标准：AF / AFL历史的患者，已经在OAC上被录取为医院，呈现出除AF / AFL以外的心律失常，以及没有足够信息的图表来计算ChADS65得分。详细审查了图表，评估了Chads65得分，ED医生决定规定OAC，转诊率到门诊诊所和跟进时机。结果：综述了1272张图表。 1124被排除在外。 148张图表被鉴定为具有由ED医生排放的ED的新发起AF / AFL患者。 24/148（16％）适当规定的OAC。 124/148（84％）没有规定的OAC。其中40/124（32％）是ChADS65 0，而其他84/124（67％）是乍得65？≥？1应该被考虑为OAC。进一步的审查确定，78/84（92％）被提交给门诊诊所，了解有关OAC的决定，其平均值（SD）日为11（±15）。重要的是，在他们预定的与中风预约之前返回1/84（1.2％）。只安排了6/84（7％）没有跟进。结论：总体而言，我们发现，ED医生对患者的OAC医生患者的速率与ChADS65分数≥1的新诊断为16％。尽管CCS 2014 2014年推荐为所有患者启动OAC的建议，但所有患者都会得分≥1。似乎ED医生正在继续推迟规定公开诊所的OAC。进一步的项目可以探索CCS指南的应用障碍，并创建知识翻译工具。

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