Canadian Community Utilization of Stroke Prevention Study - Emergency Department (C-CUSP ED)

Population Health Research Institute (PHRI)

Status: Completed

Conditions: Atrial Fibrillation; Stroke

Treatments: Other: Prescription of OAC in ED; Other: Retrospective review of OAC prescription; Other: Community AF clinic

Study type: Interventional

Funder types: Other

Identifiers

NCT02358655

C-CUSP ED

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 360 patients

Sex: All

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Prevention

Allocation: Non-Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)

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360 participants in 3 patient groups

Phase 1: Retrospective Chart Review

Other group

Description:

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.

Treatment:

Other: Retrospective review of OAC prescription

Phase 2: Low-Intensity Intervention

Other group

Description:

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.

Treatment:

Other: Prescription of OAC in ED

Phase 3: High-Intensity Intervention

Other group

Description:

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.

Treatment:

Other: Prescription of OAC in ED

Other: Community AF clinic