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Emergency Department capacity to initiate thromboprophylaxis in patients with atrial fibrillation and thrombotic risk after discharge: URGFAICS cohort analysis
- Source :
- Internal and emergency medicine, r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol, instname
- Publication Year :
- 2021
- Publisher :
- Springer Science and Business Media LLC, 2021.
-
Abstract
- Atrial fibrillation (AF) is the most prevalent heart rhythm disorder in the general population. Stroke prevention is one of the leading management objectives in the treatment of AF patients. The variables associated with the non-initiation of thromboprophylaxis in patients with thrombotic risk consulting for an episode of AF in Emergency Departments (ED) were investigated. This was a multipurpose, analytical, non-interventionist, multicenter Spanish study with a prospective 30-day follow-up. All patients >= 18 years of age consulting to the ED for the casual finding of AF in an electrocardiogram (ECG) performed 12 h prior to the consultation or with symptoms related to AF were enrolled from September 1, 2016 to February 28, 2017. Patients not previously received thromboprophylaxis were selected. Multivariate analysis was performed to calculate the odds ratio (OR) and the 95% confidence interval (CI). A total of 634 patients, not received thromboprophylaxis and at high thrombotic risk, were included. Of these, 251 (39.6%) did not receive thromboprophylaxis at ED discharge. In the multivariate analysis, non-initiation of anticoagulation at discharge from the ED was mostly related to cognitive impairment (OR 3.95; (95% CI 2.02-7.72), cancer history (OR 2.12; (95%CI 1.18-3.81), AF duration < 48 h (OR 2.49; (95% CI 1.48-4.21) and patients with re-establishment of sinus rhythm (OR 3.65; (95% CI 1.47-9.06). Reinforcement of the use of CHA(2)DS(2)-VASC as a stroke risk scale and empowerment of ED physicians is a must to improve this gap in care.
- Subjects :
- medicine.medical_specialty
Population
Risk Assessment
Risk Factors
Atrial Fibrillation
Internal Medicine
Humans
Medicine
Sinus rhythm
Prospective Studies
Thromboprophylaxis
education
Stroke
education.field_of_study
business.industry
Anticoagulants
Thrombosis
Atrial fibrillation
Venous Thromboembolism
Emergency department
Odds ratio
medicine.disease
Patient Discharge
Confidence interval
Emergency medicine
Emergency Medicine
Emergency Service, Hospital
business
Cohort study
Subjects
Details
- ISSN :
- 19709366 and 18280447
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- Internal and Emergency Medicine
- Accession number :
- edsair.doi.dedup.....46c9a0404288761d1de0ebee63bb01f0