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• W2924665525 abstract "Parkash R, Magee K, McMullen M, et al. The Canadian Community Utilization of Stroke Prevention Study in Atrial Fibrillation in the Emergency Department (C-CUSP ED). Ann Emerg Med. 2019; http://doi.org/10.1016/j.annemergmed.2018.09.001. Does an oral anticoagulation decision instrument and care bundle increase appropriate prescribing of oral anticoagulation for patients with atrial fibrillation at emergency department (ED) discharge? Design: Multicenter, pragmatic, 3-phase, before-after study. Canadian Community Utilization of Stroke Prevention Study (C-CUSP ED). ClinicalTrials.gov Identifier: NCT02358655. Setting: Five EDs in 3 urban communities in Canada. Population: A total of 631 patients not previously receiving oral anticoagulation, with ECG-documented atrial fibrillation, who were discharged from the ED at their index visit. These patients were grouped into 3 cohorts: phase 1 (n=360), including the preintervention baseline patients; phase 2 (n=145); and phase 3 (n=126) as described below. Intervention: Phase 2 consisted of decision instrument and care bundle targeting clinicians and patients to improve the prescribing and continuation of appropriately prescribed oral anticoagulation. Phase 3 had all the components of phase 2, plus a follow-up patient telephone call at 48 to 72 hours and an in-clinic visit with a cardiologist within 7 days of the initial ED encounter. Primary and Secondary Outcomes: The primary outcome was rate of new oral anticoagulant prescriptions at discharge for eligible patients. The primary analysis was between phases 1 and 3. Secondary outcomes included rates of prescriptions between phases 1 and 2 and between phases 2 and 3. Additional outcomes included major bleeding, stroke, atrial fibrillation–related ED visits, and hospitalizations in phases 2 and 3. For eligible patients, the rate of oral anticoagulation at ED discharge increased from 15.8% in phase 1 to 54.1% in phase 2 and 47.2% in phase 3 (unadjusted OR 7.10, 95% CI 3.33 to 15.13 and adjusted OR 8.03, 95% confidence interval 3.52 to 18.29 for phase 3 versus 1; unadjusted OR 8.64, 95% confidence interval 4.13 to 18.04 and adjusted OR 10.01, 95% confidence interval 4.38 to 22.86 for phase 2 versus 1).1Parkash R. Magee K. McMullen M. et al.The Canadian Community Utilization of Stroke Prevention Study in Atrial Fibrillation in the Emergency Department (C-CUSP ED).Ann Emerg Med. 2019; (http://doi.org/10.1016/j.annemergmed.2018.09.001)Google Scholar No statistically significant difference in oral anticoagulation prescription was observed when phase 3 was compared with phase 2. There was no significant difference in the rate of stroke at 6 months between groups. There was no significant difference in major bleeding between the 3 groups. Minor bleeding was observed in 0.8%, 4.0%, and 1.0% of patients in phases 1, 2, and 3, respectively. There was a significant increase in minor bleeding only in phase 2. A focused oral anticoagulation prescription intervention was associated with an increase in new oral anticoagulation prescriptions in the ED." @default.
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• W2924665525 title "Stop the Clot: Should Emergency Clinicians Champion Stroke Prevention and Prescribe Anticoagulation for Patients With Atrial Fibrillation?" @default.
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• W2924665525 doi "https://doi.org/10.1016/j.annemergmed.2019.02.010" @default.
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