Improving Emergency Department Prescribing of Anticoagulation for Atrial Fibrillation Through an Iterative Quality Improvement Process

Abstract

Objective: To assess the impact of two iterations of an emergency department (ED) atrial fibrillation (AF) pathway on anticoagulant prescribing. Methods: Two quality improvement projects gave targeted anticoagulation guidance for AF. Anticoagulation prescription rates and related adverse events were monitored across four cohorts over 9 years (2014–2023). Results: A total of 1425 patients were included. The proportion of patients discharged from ED on anticoagulation increased from 45% to 83%. Sixty-day thromboembolic events, bleeding events and all-cause mortality were unchanged. Conclusions: Targeted anticoagulation guidance within an AF pathway improved adherence without raising adverse events.