Canadian Community Utilization of Stroke Prevention Study - Emergency Department

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Canadian Community Utilization of Stroke Prevention Study - Emergency Department

Conditions
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Atrial Fibrillation, Stroke

Intervention / Treatment
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* Other: Retrospective review of OAC prescription
* Other: Prescription of OAC in ED
* Other: Community AF clinic


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who present to the emergency department with electrocardiographically documented atrial fibrillation on a 12 lead ECG Exclusion Criteria: Prosthetic or mechanical mitral or aortic valve Known rheumatic heart disease Unable to provide informed consent Will be admitted to hospital Life expectancy of < 6 months Metastatic malignancy
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Phase 1: Retrospective Chart Review<br>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. | Other: Retrospective review of OAC prescription<br> <br> |
| Other: Phase 2: Low-Intensity Intervention<br>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. | Other: Prescription of OAC in ED<br> <br> |
| Other: Phase 3: High-Intensity Intervention<br>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. | Other: Prescription of OAC in ED<br> <br> Other: Community AF clinic<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| New OAC Prescription (Phase 1 and 3 comparison) |  | Up to 72 hrs | 

Secondary Outcome Measures

| Outcome Measure | 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) |  | 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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Oral anticoagulant, Knowledge translation, Emergency department