An interventional study of Retrospective review of OAC prescription and Prescription of OAC in ED in Atrial Fibrillation and Stroke, sponsored by Population Health Research Institute. Completed at 5 sites in Canada. Per ClinicalTrials.gov, last updated 2018-10-09.
Sponsored by Population Health Research Institute · Not applicable, Interventional, and Prevention
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.
7,286 studies on the registry are indexed under Stroke; 2,007 are open to participants now.
This study's enrollment of 360 is above the median of 50 across 5,369 interventional studies indexed under Stroke.
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Exclusion Criteria:
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
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
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 · Other: Community AF clinic
New OAC Prescription (Phase 1 and 3 comparison)
Time frame: Up to 72 hrs
New OAC Prescription (Phase 1 and 2 comparison)
Time frame: Up to 72 hrs
New OAC Prescription (Phase 2 and 3 comparison)
Time frame: Up to 72 hrs
OAC use in eligible patients at 30 days (Phase 2 and 3 comparison)
Time frame: 30 days
OAC use in eligible patients at 6 months (Phase 2 and 3 comparison)
Time frame: 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.
Time frame: 6 months
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
Time frame: 6 months
This study is completed, as verified in Oct 2018. You cannot join it, but the record below documents what was studied.
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