Factors Associated with Anticoagulation Initiation for New Atrial Fibrillation in an Urban Emergency Department

Abstract

Objective: To explore factors associated with anticoagulation (AC) initiation after atrial fibrillation (AF) diagnosis.Design: Retrospective cohort study.Setting: Urban medical center.Patients: Adults with emergency depart­ment (ED) diagnosis of new onset AF from 1/1/2017-1/1/2020 discharged home.Methods: We compared patients initiated on AC, our primary outcome, to those not initiated on AC. Stroke, major bleeding, and AC initiation within 1 year of visit were secondary outcomes. We hypothesized that minority race and non-English language preference are associated with failure to initiate AC.Results: Of 111 patients with AF, 88 met inclusion criteria. Mean age was 65 (SD 15); 47 (53%) were women. 49 (56%) patients were initiated on AC. Age (61 vs 68 years; P=.02), non-English language (28% vs 10%; P=.03), leaving ED against medical advice (AMA) (36% vs 14%; P=.04), and CHA2DS2- VASc score of 1 (41% vs 6%; P<=.001) were associated with no AC initiation. There were no associations between patient-reported race/ethnicity and AC. Cardiology consultation (83.67% vs 30.78%; P<.0001) and higher median CHA2DS2-VASc score (3[2-4]) vs. 2[1-4]; P=.047) were associated with AC. Of 73 patients with follow-up data at 1 year, 2 (8%) not initiated on AC had strokes, 2 (4%) initiated on AC had major bleeds, and 15 (62.5%) not initiated on AC in the ED subsequently were initiated on AC.Conclusion: More than half of ED patients with new AF eligible for AC were initi­ated on it. Work to improve AC utilization among patients with new AF who left AMA from ED and those who prefer to commu­nicate in a non-English language may be warranted. Ethn Dis. 2022;32(4):325-332; doi:10.18865/ed.32.4.325