{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T04:44:03Z","timestamp":1793508243117,"version":"4.5.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2017,11,9]],"date-time":"2017-11-09T00:00:00Z","timestamp":1510185600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJEM"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1481803517004183_abs1\" sec-type=\"objectives\"><jats:title>Objectives<\/jats:title><jats:p>An evidence-based emergency department (ED) atrial fibrillation and flutter (AFF) pathway was developed to improve care. The primary objective was to measure rates of new anticoagulation (AC) on ED discharge for AFF patients who were not AC correctly upon presentation.<\/jats:p><\/jats:sec><jats:sec id=\"S1481803517004183_abs2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>This is a pre-post evaluation from April to December 2013 measuring the impact of our pathway on rates of new AC and other performance measures in patients with uncomplicated AFF solely managed by emergency physicians. A standardized chart review identified demographics, comorbidities, and ED treatments. The primary outcome was the rate of new AC. Secondary outcomes were ED length of stay (LOS), referrals to AFF clinic, ED revisit rates, and 30-day rates of return visits for congestive heart failure (CHF), stroke, major bleeding, and death.<\/jats:p><\/jats:sec><jats:sec id=\"S1481803517004183_abs3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>ED AFF patients totalling 301 (129 pre-pathway [PRE]; 172 post-pathway [POST]) were included; baseline demographics were similar between groups. The rates of AC at ED presentation were 18.6% (PRE) and 19.7% (POST). The rates of new AC on ED discharge were 48.6 % PRE (95% confidence interval [CI] 42.1%-55.1%) and 70.2% POST (62.1%-78.3%) (20.6% [<jats:italic>p<\/jats:italic>&lt;0.01; 15.1-26.3]). Median ED LOS decreased from 262 to 218 minutes (44 minutes [<jats:italic>p<\/jats:italic>&lt;0.03; 36.2-51.8]). Thirty-day rates of ED revisits for CHF decreased from 13.2% to 2.3% (10.9%;<jats:italic>p<\/jats:italic>&lt;0.01; 8.1%-13.7%), and rates of other measures were similar.<\/jats:p><\/jats:sec><jats:sec id=\"S1481803517004183_abs4\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>The evidence-based pathway led to an improvement in the rate of patients with new AC upon discharge, a reduction in ED LOS, and decreased revisit rates for CHF.<\/jats:p><\/jats:sec>","DOI":"10.1017\/cem.2017.418","type":"journal-article","created":{"date-parts":[[2017,11,9]],"date-time":"2017-11-09T09:06:34Z","timestamp":1510218394000},"page":"392-400","source":"Crossref","is-referenced-by-count":35,"title":["Implementation of an emergency department atrial fibrillation and flutter pathway improves rates of appropriate anticoagulation, reduces length of stay and thirty-day revisit rates for congestive heart failure"],"prefix":"10.1007","volume":"20","author":[{"given":"David","family":"Barbic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"DeWitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devin","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Stenstrom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Grafstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crane","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Vadeanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Heilbron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenelle","family":"Haaf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley","family":"Tung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Kalla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Marsden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"Christenson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Scheuermeyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2017,11,9]]},"reference":[{"key":"S1481803517004183_ref33","first-page":"368","article-title":"Clinical profile and therapeutic management of patients with atrial fibrillation in Greece: results from the Registry of Atrial Fibrillation to Investigate New Guidelines (RAFTING)","volume":"54","author":"Farmakis","year":"2013","journal-title":"Hellenic J Cardiol"},{"key":"S1481803517004183_ref37","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1086\/420936","article-title":"The use and interpretation of quasi-experimental studies in infectious diseases","volume":"38","author":"Harris","year":"2004","journal-title":"Clin Infect Dis"},{"key":"S1481803517004183_ref1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1995.00430050045005"},{"key":"S1481803517004183_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.07.009"},{"key":"S1481803517004183_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2007.12.015"},{"key":"S1481803517004183_ref4","doi-asserted-by":"publisher","DOI":"10.1097\/NRL.0b013e31815cffae"},{"key":"S1481803517004183_ref6","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-115-9-727"},{"key":"S1481803517004183_ref35","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/j.1742-6723.2005.00687.x","article-title":"Management of new onset atrial fibrillation in previously well patients less than 60 years of age","volume":"17","author":"Taylor","year":"2005","journal-title":"Emerg Med Australas"},{"key":"S1481803517004183_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.07.076"},{"key":"S1481803517004183_ref34","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-9572(00)00180-5"},{"key":"S1481803517004183_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.09.027"},{"key":"S1481803517004183_ref8","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehn101"},{"key":"S1481803517004183_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2012.01.021"},{"key":"S1481803517004183_ref36","doi-asserted-by":"publisher","DOI":"10.1159\/000151703"},{"key":"S1481803517004183_ref17","doi-asserted-by":"publisher","DOI":"10.2310\/8000.2011.110334"},{"key":"S1481803517004183_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2005.07.021"},{"key":"S1481803517004183_ref5","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000341280.31919.bd"},{"key":"S1481803517004183_ref10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2010.00697.x"},{"key":"S1481803517004183_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2007.03.007"},{"key":"S1481803517004183_ref3","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1987.00370090041008"},{"key":"S1481803517004183_ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2016.10.013"},{"key":"S1481803517004183_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2011.10.016"},{"key":"S1481803517004183_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(99)70300-8"},{"key":"S1481803517004183_ref14","first-page":"645","article-title":"Emergency physician patterns related to anticoagulation of patients with recent-onset atrial fibrillation and flutter","volume":"5","author":"Misra","year":"2013","journal-title":"J Atr Fibrillation"},{"key":"S1481803517004183_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2013.04.004"},{"key":"S1481803517004183_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.03.025"},{"key":"S1481803517004183_ref20","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12750"},{"key":"S1481803517004183_ref21","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960251003"},{"key":"S1481803517004183_ref22","unstructured":"Statistics Canada. 82-625-X. Access to a regular medical doctor; 2014. Available at: http:\/\/www.statcan.gc.ca\/pub\/82-625-x\/2015001\/article\/14177-eng.htm (accessed 3 July 2017)."},{"key":"#cr-split#-S1481803517004183_ref23.1","unstructured":"2. Barua B, Ren F . Fraser Institute. Waiting your turn: wait times for health care in Canada, 2016 report"},{"key":"#cr-split#-S1481803517004183_ref23.2","unstructured":"3. 2016. Available at: http:\/\/www.fraserinstitute.org."},{"key":"S1481803517004183_ref24","volume-title":"Health care in Canada, 2012: a focus on wait times","year":"2012"},{"key":"S1481803517004183_ref26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.annemergmed.2014.07.016","article-title":"Stroke prophylaxis in atrial fibrillation: searching for management improvement opportunities in the emergency department: the HERMES-AF study","volume":"65","author":"Coll-Vinent","year":"2015","journal-title":"Ann Emerg Med"},{"key":"S1481803517004183_ref27","first-page":"666","article-title":"Atrial fibrillation: a primary care cross-sectional study","volume":"13","author":"Mashal","year":"2011","journal-title":"Isr Med Assoc J"},{"key":"S1481803517004183_ref28","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1996.00440210043004"},{"key":"S1481803517004183_ref30","doi-asserted-by":"publisher","DOI":"10.1097\/HPC.0000000000000008"},{"key":"S1481803517004183_ref31","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2003.22"},{"key":"S1481803517004183_ref32","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1136\/emj.2009.083196","article-title":"Cardioversion of acute atrial fibrillation in the short observation unit: comparison of a protocol focused on electrical cardioversion with simple antiarrhythmic treatment","volume":"28","author":"Cristoni","year":"2011","journal-title":"Emerg Med J"},{"key":"S1481803517004183_ref38","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2015.03.024"}],"container-title":["CJEM"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1481803517004183","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T13:35:34Z","timestamp":1719581734000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1481803517004183\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,9]]},"references-count":39,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,5]]}},"alternative-id":["S1481803517004183"],"URL":"https:\/\/doi.org\/10.1017\/cem.2017.418","relation":{},"ISSN":["1481-8035","1481-8043"],"issn-type":[{"value":"1481-8035","type":"print"},{"value":"1481-8043","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,9]]}}}