{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T18:24:08Z","timestamp":1761848648785,"version":"build-2065373602"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"funder":[{"DOI":"10.13039\/100012512","name":"Canadian Association of Emergency Physicians","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012512","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100032667","name":"CanVECTOR","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100032667","id-type":"DOI","asserted-by":"crossref"}]},{"name":"University of Ottawa, Department of Emergency Medicine"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Can J Emerg Med"],"published-print":{"date-parts":[[2025,10]]},"DOI":"10.1007\/s43678-025-00991-6","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T08:14:14Z","timestamp":1761207254000},"page":"796-806","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-utility analysis of routine oral anticoagulation for low-risk patients undergoing cardioversion for atrial fibrillation and flutter"],"prefix":"10.1007","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9590-7497","authenticated-orcid":false,"given":"Shawn","family":"Chhabra","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krishan","family":"Yadav","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel","family":"Cortel-LeBlanc","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Costello","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Stiell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kednapa","family":"Thavorn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"issue":"4","key":"991_CR1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-033482","volume":"10","author":"KL Hong","year":"2020","unstructured":"Hong KL, Babiolakis C, Zile B, Bullen M, Haseeb S, Halperin F, et al. Canada-wide mixed methods analysis evaluating the reasons for inappropriate emergency department presentation in patients with a history of atrial fibrillation: the multicentre AF-ED trial. BMJ Open. 2020;10(4): e033482.","journal-title":"BMJ Open"},{"issue":"6","key":"991_CR2","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1016\/j.annemergmed.2013.06.005","volume":"62","author":"CL Atzema","year":"2013","unstructured":"Atzema CL, Austin PC, Miller E, Chong AS, Yun L, Dorian P. A population-based description of atrial fibrillation in the emergency department, 2002 to 2010. Ann Emerg Med. 2013;62(6):570\u20137.","journal-title":"Ann Emerg Med"},{"issue":"4","key":"991_CR3","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1093\/europace\/eus333","volume":"15","author":"T Wilke","year":"2013","unstructured":"Wilke T, Groth A, Mueller S, Pfannkuche M, Verheyen F, Linder R, et al. Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Europace. 2013;15(4):486\u201393.","journal-title":"Europace"},{"issue":"12","key":"991_CR4","first-page":"1847","volume":"36","author":"JG Andrade","year":"2020","unstructured":"Andrade JG, Aguilar M, Atzema C, Bell A, Cairns JA, Cheung CC, et al. The 2020 Canadian Cardiovascular Society\/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation. Canad J Cardiol. 2020;36(12):1847\u2013948.","journal-title":"Canad J Cardiol"},{"key":"991_CR5","unstructured":"Public Health Agency of Canada. Stroke in Canada\u202f: highlights from the Canadian Chronic Disease Surveillance System. 2017;4."},{"key":"991_CR6","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1056\/NEJMoa1310907","volume":"369","author":"RP Giugliano","year":"2013","unstructured":"Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369:2093\u2013104.","journal-title":"N Engl J Med"},{"key":"991_CR7","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1056\/NEJMoa1009638","volume":"365","author":"MR Patel","year":"2011","unstructured":"Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation * A complete listing of the steering com-mittee members and trial investigators in the Rivaroxaban Once Daily Oral Di-rect Factor Xa Inhibition Compared with Vitamin K Antagonism for Preven-tion of Stroke and Embolism Trial in Atrial Fibrillation. N Engl J Med. 2011;365:883\u201391.","journal-title":"N Engl J Med"},{"issue":"15","key":"991_CR8","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1056\/NEJMoa1107039","volume":"11","author":"CB Granger","year":"2011","unstructured":"Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus Warfarin in Patients with Atrial Fibrillation for the ARISTOTLE Committees and Investigators. N Engl J Med. 2011;11(15):981\u201392.","journal-title":"N Engl J Med"},{"issue":"12","key":"991_CR9","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1056\/NEJMoa0905561","volume":"361","author":"SJ Connolly","year":"2009","unstructured":"Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. New England J Med. 2009;361(12):1139\u201351. https:\/\/doi.org\/10.1056\/NEJMoa0905561.","journal-title":"New England J Med"},{"issue":"13","key":"991_CR10","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1016\/j.jacc.2013.04.089","volume":"62","author":"KEJ Airaksinen","year":"2013","unstructured":"Airaksinen KEJ, Gr\u00f6nberg T, Nuotio I, Nikkinen M, Ylitalo A, Biancari F, et al. Thromboembolic complications after cardioversion of acute atrial fibrillation: the FinCV (Finnish CardioVersion) study. J Am Coll Cardiol. 2013;62(13):1187\u201392.","journal-title":"J Am Coll Cardiol"},{"issue":"4","key":"991_CR11","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1016\/j.jacep.2016.01.018","volume":"2","author":"A Garg","year":"2016","unstructured":"Garg A, Khunger M, Seicean S, Chung MK, Tchou PJ. Incidence of thromboembolic complications within 30 days of electrical cardioversion performed within 48 hours of atrial fibrillation onset. JACC Clin Electrophysiol. 2016;2(4):487\u201394.","journal-title":"JACC Clin Electrophysiol"},{"issue":"203","key":"991_CR12","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/j.ijcard.2015.10.168","volume":"15","author":"A Palom\u00e4ki","year":"2016","unstructured":"Palom\u00e4ki A, Mustonen P, Hartikainen JEK, Nuotio I, Kiviniemi T, Ylitalo A, et al. Strokes after cardioversion of atrial fibrillation \u2014 The FibStroke study. Int J Cardiol. 2016;15(203):269\u201373.","journal-title":"Int J Cardiol"},{"issue":"215","key":"991_CR13","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1016\/j.ijcard.2016.04.031","volume":"15","author":"S Sj\u00e4lander","year":"2016","unstructured":"Sj\u00e4lander S, Svensson PJ, Friberg L. Atrial fibrillation patients with CHA2DS2-VASc > 1 benefit from oral anticoagulation prior to cardioversion. Int J Cardiol. 2016;15(215):360\u20133.","journal-title":"Int J Cardiol"},{"key":"991_CR14","first-page":"1371","volume":"34","author":"JG Andrade","year":"2018","unstructured":"Andrade JG, Verma A, Mitchell LB, et al. Focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation. Can J Cardiol. 2018;34:1371.","journal-title":"Can J Cardiol"},{"issue":"5","key":"991_CR15","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1007\/s43678-021-00167-y","volume":"23","author":"IG Stiell","year":"2021","unstructured":"Stiell IG, de Wit K, Scheuermeyer FX, Vadeboncoeur A, Angaran P, Eagles D, et al. CAEP acute atrial fibrillation\/flutter best practices checklist. Can J Emerg Med. 2021;23(5):604\u201310. https:\/\/doi.org\/10.1007\/s43678-021-00167-y.","journal-title":"Can J Emerg Med"},{"issue":"1","key":"991_CR16","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.1161\/CIR.0000000000001193","volume":"149","author":"JA Joglar","year":"2023","unstructured":"Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, et al. ACC\/AHA\/ACCP\/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: a report of the american college of cardiology\/american heart association joint committee on clinical practice guidelines. Circulation. 2023;149(1):E1-156. https:\/\/doi.org\/10.1161\/CIR.0000000000001193.","journal-title":"Circulation"},{"issue":"5","key":"991_CR17","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","volume":"42","author":"G Hindricks","year":"2020","unstructured":"Hindricks G, Potpara T, Kirchhof P, K\u00fchne M, Ahlsson A, Balsam P, et al. ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2020;42(5):373\u2013498. https:\/\/doi.org\/10.1093\/eurheartj\/ehaa612.","journal-title":"Eur Heart J"},{"key":"991_CR18","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1007\/s43678-021-00103-0","volume":"23","author":"BM Wong","year":"2021","unstructured":"Wong BM, Perry JJ, Cheng W, Zheng B, Guo K, Taljaard M, et al. Thromboembolic events following cardioversion of acute atrial fibrillation and flutter: a systematic review and meta-analysis. Can J Emerg Med. 2021;23:500\u201311. https:\/\/doi.org\/10.1007\/s43678-021-00103-0.","journal-title":"Can J Emerg Med"},{"key":"991_CR19","unstructured":"Guidelines for the Economic Evaluation of Health Technologies: Canada 4th Edition CADTH METHODS AND GUIDELINES Service Line: CADTH Methods and Guidelines. 2017."},{"issue":"9921","key":"991_CR20","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1016\/S0140-6736(13)62343-0","volume":"383","author":"CT Ruff","year":"2014","unstructured":"Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955\u201362.","journal-title":"Lancet"},{"issue":"11","key":"991_CR21","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.1111\/jth.13140","volume":"13","author":"S Kaatz","year":"2015","unstructured":"Kaatz S, Ahmad D, Spyropoulos AC, Schulman S. Definition of clinically relevant non-major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the SSC of the ISTH. J Thromb Haemost. 2015;13(11):2119\u201326. https:\/\/doi.org\/10.1111\/jth.13140.","journal-title":"J Thromb Haemost"},{"issue":"12","key":"991_CR22","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1161\/CIRCULATIONAHA.123.064556","volume":"148","author":"R Aggarwal","year":"2023","unstructured":"Aggarwal R, Ruff CT, Virdone S, Perreault S, Kakkar AK, Palazzolo MG, et al. Development and validation of the DOAC score: a novel bleeding risk prediction tool for patients with atrial fibrillation on direct-acting oral anticoagulants. Circulation. 2023;148(12):936\u201346. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.123.064556.","journal-title":"Circulation"},{"key":"991_CR23","doi-asserted-by":"publisher","first-page":"2824","DOI":"10.1161\/STROKEAHA.123.043369","volume":"11","author":"MV Vyas","year":"2023","unstructured":"Vyas MV, Fang J, de Oliveira C, Austin PC, Yu AYX, Kapral MK. Attributable costs of stroke in Ontario, Canada and their variation by stroke type and social determinants of health. Stroke. 2023;11:2824\u201331. https:\/\/doi.org\/10.1161\/STROKEAHA.123.043369.","journal-title":"Stroke"},{"key":"991_CR24","unstructured":"Formulary Search [Internet]. [cited 2025 Feb 27]. Available from: https:\/\/www.formulary.health.gov.on.ca\/formulary\/"},{"key":"991_CR25","unstructured":"Inflation Calculator - Bank of Canada [Internet]. [cited 2024 Jan 11]. Available from: https:\/\/www.bankofcanada.ca\/rates\/related\/inflation-calculator\/"},{"issue":"1","key":"991_CR26","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1007\/s12325-022-02333-9","volume":"40","author":"S Ballestri","year":"2023","unstructured":"Ballestri S, Romagnoli E, Arioli D, Coluccio V, Marrazzo A, Athanasiou A, et al. Risk and management of bleeding complications with direct oral anticoagulants in patients with atrial fibrillation and venous thromboembolism: a narrative review. Adv Ther. 2023;40(1):41.","journal-title":"Adv Ther"},{"issue":"2","key":"991_CR27","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.hroo.2022.11.003","volume":"4","author":"JG Andrade","year":"2022","unstructured":"Andrade JG, Shah A, Godin R, Lanitis T, Kongnakorn T, Brown L, et al. Cost-effectiveness of atrial fibrillation screening in Canadian community practice. Heart Rhythm O2. 2022;4(2):103\u201310.","journal-title":"Heart Rhythm O2"},{"issue":"40","key":"991_CR28","doi-asserted-by":"publisher","first-page":"E1551","DOI":"10.1503\/cmaj.210523","volume":"193","author":"M Kimpton","year":"2021","unstructured":"Kimpton M, Kumar S, Wells PS, Coyle D, Carrier M, Thavorn K. Cost-utility analysis of apixaban compared with usual care for primary thromboprophylaxis in ambulatory patients with cancer. CMAJ. 2021;193(40):E1551\u201360.","journal-title":"CMAJ"},{"issue":"6","key":"991_CR29","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1177\/0272989X11401031","volume":"31","author":"PW Sullivan","year":"2011","unstructured":"Sullivan PW, Slejko JF, Sculpher MJ, Ghushchyan V. Catalogue of EQ-5D scores for the United Kingdom. Med Decis Making. 2011;31(6):800\u20134.","journal-title":"Med Decis Making"},{"issue":"2","key":"991_CR30","doi-asserted-by":"publisher","first-page":"E007230","DOI":"10.1161\/CIRCOUTCOMES.120.007230","volume":"14","author":"CA Jackevicius","year":"2021","unstructured":"Jackevicius CA, Lu L, Ghaznavi Z, Warner AL. Bleeding risk of direct oral anticoagulants in patients with heart failure and atrial fibrillation. Circ Cardiovasc Qual Outcomes. 2021;14(2):E007230. https:\/\/doi.org\/10.1161\/CIRCOUTCOMES.120.007230.","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"5","key":"991_CR31","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1017\/cem.2019.399","volume":"21","author":"IG Stiell","year":"2019","unstructured":"Stiell IG, Mcmurtry MS, Mcrae A, Parkash R, Scheuermeyer F, Atzema CL, et al. The Canadian Cardiovascular Society 2018 guideline update for atrial fibrillation \u2013 A different perspective. Can J Emerg Med. 2019;21(5):572\u20135.","journal-title":"Can J Emerg Med"},{"issue":"2","key":"991_CR32","first-page":"229","volume":"29","author":"DJ O\u2019Reilly","year":"2013","unstructured":"O\u2019Reilly DJ, Hopkins RB, Healey JS, Dorian P, Sauriol L, Tarride JE, et al. The burden of atrial fibrillation on the hospital sector in Canada. Can J Cardiol. 2013;29(2):229\u201335.","journal-title":"Can J Cardiol"},{"issue":"49","key":"991_CR33","doi-asserted-by":"publisher","first-page":"E1345","DOI":"10.1503\/cmaj.190747","volume":"191","author":"CL Atzema","year":"2019","unstructured":"Atzema CL, Jackevicius CA, Chong A, Dorian P, Ivers NM, Parkash R, et al. Prescribing of oral anticoagulants in the emergency department and subsequent long-term use by older adults with atrial fibrillation. CMAJ. 2019;191(49):E1345\u201354.","journal-title":"CMAJ"},{"key":"991_CR34","unstructured":"Formulary Search [Internet]. [cited 2024 Feb 1]. Available from: https:\/\/www.formulary.health.gov.on.ca\/formulary\/"},{"issue":"42008","key":"991_CR35","doi-asserted-by":"publisher","first-page":"147","DOI":"10.3111\/200508147167","volume":"8","author":"R Goeree","year":"2005","unstructured":"Goeree R, Blackhouse G, Petrovic R, Salama S. Cost of stroke in Canada: a 1-year prospective study. J Med Econ. 2005;8(42008):147\u201367.","journal-title":"J Med Econ"},{"issue":"Supplement_1","key":"991_CR36","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1182\/blood-2019-127286","volume":"134","author":"M Kimpton","year":"2019","unstructured":"Kimpton M, Kumar S, Wells PS, Carrier M, Thavorn K. Cost-utility analysis of apixaban compared to usual care for the primary thromboprophylaxis of ambulatory cancer patients initiating chemotherapy. Blood. 2019;134(Supplement_1):329\u2013329. https:\/\/doi.org\/10.1182\/blood-2019-127286.","journal-title":"Blood"},{"issue":"7","key":"991_CR37","doi-asserted-by":"publisher","first-page":"949","DOI":"10.7326\/M22-3559","volume":"176","author":"F Khan","year":"2023","unstructured":"Khan F, Coyle D, Thavorn K, van Katwyk S, Tritschler T, Hutton B, et al. Indefinite anticoagulant therapy for first unprovoked venous thromboembolism\u202f: a cost-effectiveness study. Ann Intern Med. 2023;176(7):949\u201361.","journal-title":"Ann Intern Med"},{"issue":"182","key":"991_CR38","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.thromres.2019.07.026","volume":"1","author":"Y Xu","year":"2019","unstructured":"Xu Y, Schulman S, Dowlatshahi D, Holbrook AM, Simpson CS, Shepherd LE, et al. Healthcare resource utilization and costs among patients with direct oral anticoagulant or warfarin-related major bleeding. Thromb Res. 2019;1(182):12\u20139.","journal-title":"Thromb Res"},{"issue":"17","key":"991_CR39","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1056\/NEJMra2201449","volume":"387","author":"KN Sheth","year":"2022","unstructured":"Sheth KN. Spontaneous intracerebral hemorrhage. Ropper AH, editor. N Engl J Med. 2022;387(17):1589\u201396.","journal-title":"N Engl J Med"}],"container-title":["Canadian Journal of Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43678-025-00991-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s43678-025-00991-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43678-025-00991-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T18:06:07Z","timestamp":1761847567000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s43678-025-00991-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":39,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["991"],"URL":"https:\/\/doi.org\/10.1007\/s43678-025-00991-6","relation":{},"ISSN":["1481-8035","1481-8043"],"issn-type":[{"type":"print","value":"1481-8035"},{"type":"electronic","value":"1481-8043"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"31 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"SC, KY, IS, and KT report no conflict of interest. MCL has received honoraria from AbbVie, Lundbeck, and Pfizer for speaking engagements. He has also received consulting fees for the provision of medico-legal expert opinions and is a minority shareholder in a health technology company. During parts of this study, AC conducted unrelated work for AstraZeneca and a health consultancy.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}