Evidence map›Paper›PMID 38530599›Full record

ArticleCJEM2024

How well do ED physician practices align with the CAEP acute atrial fibrillation checklist for stroke prevention and disposition?

Samara Adler, Amanda M S Mattice, Debra Eagles, Krishan Yadav, Sean Hui, Althaf Azward, Nikesh Pandey, Ian Stiell

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in CJEM, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.8field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 2 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Samara AdlerDepartment of Emergency Medicine, University of Ottawa and Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada. sadler@toh.ca.
Amanda M S MatticeDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Debra EaglesDepartment of Emergency Medicine, University of Ottawa and Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.
Krishan YadavDepartment of Emergency Medicine, University of Ottawa and Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.
Sean HuiFaculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Althaf AzwardFaculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Nikesh PandeyFaculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Ian StiellDepartment of Emergency Medicine, University of Ottawa and Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.
University of Ottawa · CAOttawa Hospital · CAOttawa Hospital Research Institute

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesAcute atrial fibrillation (AF)/flutter (AFL) is a common emergency department (ED) presentation. In 2021, an updated version of CAEP's Acute AF/AFL Best Practices Checklist was published, seeking to guide management. We assessed the alignment with and safety of application of the Checklist, regarding stroke prevention and disposition.

methodsThis health records review included adults presenting to two tertiary care academic EDs between January and August 2022 with a diagnosis of acute AF/AFL. Patients were excluded if their initial heart rate was < 100 or if they were hospitalized. Data extracted included: demographics, CHADS-65 score, clinical characteristics, ED treatment and disposition, and outpatient prescriptions and referrals. Our primary outcome was the proportion of patient encounters with one or more identified safety issues. Each case was assessed according to seven predetermined criteria from elements of the CAEP Checklist and either deemed "safe" or to contain one or more safety issues. We used descriptive statistics with 95% confidence intervals.

results358 patients met inclusion criteria. The mean age was 66.9 years, 59.2% were male and 77.4% patients had at least one of the CHADS-65 criteria. 169 (47.2%) were not already on anticoagulation and 99 (27.6%) were discharged home with a new prescription for anticoagulation. The primary outcome was identified in 6.4% (95% CI 4.3-9.5) of encounters, representing 28 safety issues in 23 individuals. The safety concerns included: failure to prescribe anticoagulation when indicated (n = 6), inappropriate dosing of a direct oral anticoagulant (DOAC) (n = 2), inappropriate prescription of rate or rhythm control medication (n = 9), and failure to recommend appropriately timed follow-up for new rate control medication (n = 11).

conclusionsThere was a very high level of ED physician alignment with CAEP's Best Practices Checklist regarding disposition and stroke prevention. There are opportunities to further improve care with respect to recommendation of anticoagulation and reducing inappropriate prescriptions of rate or rhythm medications.

Indexed as

Atrial FibrillationChecklistEmergency Service, HospitalStrokeAcute DiseaseAgedAnticoagulantsFemaleGuideline AdherenceHumansMaleMiddle AgedPractice Patterns, Physicians'Retrospective StudiesAnticoagulantsAnticoagulationAtrial fibrillationAtrial flutterStroke prevention

Identifiers

PMID38530599
OpenAlexW4393193288

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.