Johanna Seiden, Samantha Lessen, Natalie T Cheng, Benjamin W Friedman, Daniel L Labovitz, Charles C Esenwa, Ava L Liberman
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We hypothesized that minority race and non-English language preference are associated with failure to initiate AC.</p><p><strong>Results: </strong>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 CHA<sup>2</sup>DS<sup>2</sup>-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 CHA<sup>2</sup>DS<sup>2</sup>-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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9590604/pdf/ethndis-32-325.pdf","citationCount":"1","resultStr":"{\"title\":\"Factors Associated with Anticoagulation Initiation for New Atrial Fibrillation in an Urban Emergency Department.\",\"authors\":\"Johanna Seiden, Samantha Lessen, Natalie T Cheng, Benjamin W Friedman, Daniel L Labovitz, Charles C Esenwa, Ava L Liberman\",\"doi\":\"10.18865/ed.32.4.325\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To explore factors associated with anticoagulation (AC) initiation after atrial fibrillation (AF) diagnosis.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Urban medical center.</p><p><strong>Patients: </strong>Adults with emergency department (ED) diagnosis of new onset AF from 1/1/2017-1/1/2020 discharged home.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 CHA<sup>2</sup>DS<sup>2</sup>-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 CHA<sup>2</sup>DS<sup>2</sup>-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.</p><p><strong>Conclusion: </strong>More than half of ED patients with new AF eligible for AC were initiated on it. 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引用次数: 1
摘要
目的:探讨房颤(AF)诊断后抗凝(AC)启动的相关因素。设计:回顾性队列研究。环境:城市医疗中心。患者:2017年1月1日至2020年1月1日急诊诊断为新发房颤的成人出院。方法:我们比较了开始AC治疗的患者(我们的主要结局)和未开始AC治疗的患者。卒中、大出血和就诊1年内开始AC治疗是次要结局。我们假设少数民族和非英语语言偏好与未能启动ac相关。结果:111例AF患者中，88例符合纳入标准。平均年龄65岁(SD 15);47例(53%)为女性。49例(56%)患者开始接受AC治疗。年龄(61 vs 68岁;P=.02)，非英语语言(28% vs 10%;P=.03)，不遵医嘱离开急诊科(36% vs 14%;P=.04)， CHA2DS2-VASc评分为1分(41% vs 6%;P2DS2-VASc评分(3[2-4])vs. 2[1-4];P= 0.047)与AC相关。在73例随访1年的患者中，2例(8%)未开始AC治疗发生卒中，2例(4%)开始AC治疗发生大出血，15例(62.5%)未开始AC治疗的ED患者随后开始AC治疗。结论:超过一半的符合AC治疗条件的新发房颤ED患者开始AC治疗。在从急诊科离开AMA的新房颤患者和那些喜欢用非英语语言交流的患者中，改善交流的使用可能是有必要的。
Factors Associated with Anticoagulation Initiation for New Atrial Fibrillation in an Urban Emergency Department.
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.
期刊介绍：
Ethnicity & Disease is an international journal that exclusively publishes information on the causal and associative relationships in the etiology of common illnesses through the study of ethnic patterns of disease. Topics focus on: ethnic differentials in disease rates;impact of migration on health status; social and ethnic factors related to health care access and health; and metabolic epidemiology. A major priority of the journal is to provide a forum for exchange between the United States and the developing countries of Europe, Africa, Asia, and Latin America.
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