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Atrial fibrillation (AF) is a common heart condition, and increases the risk of stroke by six times. There are several medications (blood thinners) that can prevent strokes in AF patients. Many AF patients present to the emergency department, but about half of AF patients leave without prescription of a blood thinner. The study aims to evaluate if adding options like giving a patient education kit, encouraging emergency room physicians to prescribe a blood thinner and providing a specialized AF clinic to patients will increase the number patients receiving blood thinners to prevent strokes.
This is a knowledge translation study will occur in three consecutive phases: Phase 1 is a retrospective chart review of all patients who presented to the emergency department (ED) with ECG documented AF during 1 year prior to study commencement. The main purpose of Phase 1 is to determine if oral anticoagulants (OACs) were prescribed for eligible AF patients at ED discharge. In Phase 2 a low-intensity intervention will be applied in the ED during 6 months, involving physician education, distribution of an AF patient education package, short-term OAC prescription, and a follow-up letter to the patient's family physician. After a one month transition phase, a high intensity intervention will be applied during 6 months in Phase 3. Phase 3 incorporates the Phase 2 intervention, and adds immediate follow-up (within 48-72 hours) in a community AF clinic run by a nurse/pharmacist who is supervised by a specialist in AF.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Phase 1: Retrospective Chart Review | Other | Retrospective chart review of all patients who presented to the emergency department (ED) with ECG-documented AF during 1 year prior to study commencement. The main purpose of Phase 1 is to determine if oral anticoagulants were prescribed for eligible AF patients at ED discharge. |
|
| Phase 2: Low-Intensity Intervention | Other | Low-intensity intervention will be applied in the ED during 6 months, involving physician education, distribution of an AF patient education package, short-term oral anticoagulant prescription, and a follow-up letter to the patient's family physician. |
|
| Phase 3: High-Intensity Intervention | Other | Phase 3 incorporates the Phase 2 intervention, and adds immediate follow-up (within 48-72 hours) in a community AF clinic run by a nurse/pharmacist who is supervised by a specialist in AF. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Retrospective review of OAC prescription | Other |
| ||
| Prescription of OAC in ED |
| Measure | Description | Time Frame |
|---|---|---|
| New OAC Prescription (Phase 1 and 3 comparison) | Up to 72 hrs |
| Measure | Description | Time Frame |
|---|---|---|
| New OAC Prescription (Phase 1 and 2 comparison) | Up to 72 hrs | |
| New OAC Prescription (Phase 2 and 3 comparison) | Up to 72 hrs | |
| OAC use in eligible patients at 30 days (Phase 2 and 3 comparison) |
| Measure | Description | Time Frame |
|---|---|---|
| Safety related to OAC, as measured by rates of adverse events related to OAC including major bleeding and minor bleeding | Rates of adverse events related to OAC including major bleeding and minor bleeding will be assessed | 6 months |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ratika Parkash, MD | Dalhousie University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Lions Gate Hospital | North Vancouver | British Columbia | Canada | |||
| Dr. Georges-L.-Dumont University Hospital Centre |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30502307 | Derived | Parkash R, Magee K, McMullen M, Clory M, D'Astous M, Robichaud M, Andolfatto G, Read B, Wang J, Thabane L, Atzema C, Dorian P, Kaczorowski J, Banner D, Nieuwlaat R, Ivers N, Huynh T, Curran J, Graham I, Connolly S, Healey J. The Canadian Community Utilization of Stroke Prevention Study in Atrial Fibrillation in the Emergency Department (C-CUSP ED). Ann Emerg Med. 2019 Apr;73(4):382-392. doi: 10.1016/j.annemergmed.2018.09.001. Epub 2018 Oct 26. |
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| ID | Term |
|---|---|
| D001281 | Atrial Fibrillation |
| D020521 | Stroke |
| D004630 | Emergencies |
| ID | Term |
|---|---|
| D001145 | Arrhythmias, Cardiac |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D010335 | Pathologic Processes |
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| Other |
|
| Community AF clinic | Other |
|
| 30 days |
| OAC use in eligible patients at 6 months (Phase 2 and 3 comparison) | 6 months |
| Uptake of study interventions | This outcome measure is meant to determine feasibility for a larger community cluster RCT. This will be measured by the uptake of the interventions described in this study, including: patient use of the AF educational kit, patient use of AF clinic, attendance at educational presentations for patients, family doctors and emergency physicians, patient use of automated text or email reminders for OACs. | 6 months |
| Moncton |
| New Brunswick |
| Canada |
| Dartmouth General Hospital | Dartmouth | Nova Scotia | Canada |
| Cobequid Community Health Centre | Halifax | Nova Scotia | Canada |
| Halifax Infirmary | Halifax | Nova Scotia | Canada |
| D013568 |
| Pathological Conditions, Signs and Symptoms |
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D014652 | Vascular Diseases |
| D020969 | Disease Attributes |