An Emergency Department Intervention to Increase Warfarin Use for Atrial Fibrillation

Abstract

Emergency department (ED) encounters represent lost opportunities to facilitate anticoagulation for stroke prevention in atrial fibrillation (AF). However, screening of warfarin eligibility in the ED may not be feasible. We evaluated whether a practical quality improvement initiative increased postdischarge warfarin use in ED patients with AF. This quasiexperimental study was conducted in a single academic health system. Eligible subjects were consecutive patients with AF identified by electrocardiogram during an ED evaluation who were discharged from the ED or the subsequent hospitalization off warfarin. The study consisted of data collection during 2 time periods: (1) preintervention (October 2009 to April 2010), serving as a baseline, and (2) intervention (June 2010 to December 2010). The intervention consisted of a mailing to the subjects and their primary care physicians. The primary outcome was the proportion of subjects taking warfarin 1month after ED presentation. Differences between the proportion of preintervention and intervention subjects taking warfarin and warfarin or aspirin were compared with Chi-square tests. At 1 month, 111 of 204 (55%) of the eligible preintervention and 90 of 160 (56%) of the eligible intervention group patients participated. There was no difference between the preintervention and intervention groups in theproportion of subjects taking warfarin at 1 month (12% v 9%; P=.54) or the proportion of subjects taking either aspirin or warfarin at 1 month (72% v 75%; P=.59). This practical stroke prevention quality improvement initiative was not associated with an increase in warfarin use among ED patients with AF.