Emergency department training on the appropriate prescription of anticoagulants in atrial fibrillation and on patient follow-up after discharge

Objectives. The main objective was to evaluate the effect of an emergency department training intervention on the use of a protocol for prescribing anticoagulant therapy in atrial fibrillation and on following patients after discharge. Methods. Quasi-experimental pre-post study of a training intervention; the control patients were not matched but were selected consecutively before and after the intervention. All patients were over the age of 18 years, had atrial fibrillation identified by electrocardiogram, and indications for anticoagulant therapy, specifically a score of 2 or more on the CHADS2-DS2-VASc scale (cardiac failure, hypertension, age >75 years, diabetes, stroke [doubled], vascular disease, age 65-74 years, sex). The primary outcome was percentage of patients on anticoagulant therapy on discharge from the department. The secondary outcome was the percentage of patients on therapy 1 month after discharge. Results. A total of 184 patients (86 before the intervention and 98 afterwards) were included. Training significantly increased the prescription of anticoagulants in the department (before the intervention, 32 patients [37%] vs 95 [97%] afterwards; P<.001). In the preintervention period, 26 patients (30% were on anticoagulants 1 month later; in the postintervention period, 26(30%) were still on therapy (P<.001). Conclusions. This study shows that emergency staff training is effective for implementing protocols based on anticoagulant therapy guidelines.