title: Benefits of Emergency Departments' Contribution to Stroke Prophylaxis in Atrial Fibrillation: The EMERG-AF Study (Emergency Department Stroke Prophylaxis and Guidelines Implementation in Atrial Fibrillation).
abstract: Long-term benefits of initiating stroke prophylaxis in the emergency department (ED) are unknown. We analyzed the long-term safety and benefits of ED prescription of anticoagulation in atrial fibrillation patients.
  
  
  
  Prospective, multicenter, observational cohort of consecutive atrial fibrillation patients was performed in 62 Spanish EDs. Clinical variables and thromboprophylaxis prescribed at discharge were collected at inclusion. Follow-up at 1 year post-discharge included data about thromboprophylaxis and its complications, major bleeding, and death; risk was assessed with univariate and bivariate logistic regression models.
  
  
  
  We enrolled 1162 patients, 1024 (88.1%) at high risk according to CHA2DS2-VASc score. At ED discharge, 935 patients (80.5%) were receiving anticoagulant therapy, de novo in 237 patients (55.2% of 429 not previously treated). At 1 year, 48 (4.1%) patients presented major bleeding events, and 151 (12.9%) had died. Anticoagulation first prescribed in the ED was not related to major bleeding (hazard ratio, 0.976; 95% confidence interval, 0.294-3.236) and was associated with a decrease in mortality (hazard ratio, 0.398; 95% confidence interval, 0.231-0.686). Adjusting by the main clinical and sociodemographic characteristics, concomitant antiplatelet treatment, or destination (discharge or admission) did not affect the results.
  
  
  
  Prescription of anticoagulation in the ED does not increase bleeding risk in atrial fibrillation patients at high risk of stroke and contributes to decreased mortality.
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.). bcvinent@clinic.cat.
authors.forename: Blanca
authors.initials: B
authors.lastname: Coll-Vinent
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).
authors.forename: Alfonso
authors.initials: A
authors.lastname: Martín
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).
authors.forename: Juan
authors.initials: J
authors.lastname: Sánchez
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).
authors.forename: Juan
authors.initials: J
authors.lastname: Tamargo
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).
authors.forename: Coral
authors.initials: C
authors.lastname: Suero
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).
authors.forename: Francisco
authors.initials: F
authors.lastname: Malagón
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).
authors.forename: Mercedes
authors.initials: M
authors.lastname: Varona
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).
authors.forename: Manuel
authors.initials: M
authors.lastname: Cancio
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).
authors.forename: Susana
authors.initials: S
authors.lastname: Sánchez
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).
authors.forename: José
authors.initials: J
authors.lastname: Carbajosa
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).
authors.forename: José
authors.initials: J
authors.lastname: Ríos
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).
authors.forename: Georgina
authors.initials: G
authors.lastname: Casanovas
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).
authors.forename: Carles
authors.initials: C
authors.lastname: Ràfols
authors.affiliation: From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).
authors.forename: Carmen
authors.initials: C
authors.lastname: Del Arco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology*; D001281:Atrial Fibrillation / Q000401:mortality / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000401:mortality / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: anticoagulants; atrial fibrillation; hemorrhage; mortality stroke