Canadian Community Utilization of Stroke Prevention Study - Emergency Department "C-CUSP ED"

Active, not recruiting

Phase N/A Results N/A

Trial Description

Atrial fibrillation (AF) is a common heart condition, and increases the risk of stroke by six times. There are several medications (blood thinners) that can prevent strokes in AF patients. Many AF patients present to the emergency department, but about half of AF patients leave without prescription of a blood thinner. The study aims to evaluate if adding options like giving a patient education kit, encouraging emergency room physicians to prescribe a blood thinner and providing a specialized AF clinic to patients will increase the number patients receiving blood thinners to prevent strokes.

Detailed Description

This is a knowledge translation study will occur in three consecutive phases: Phase 1 is a retrospective chart review of all patients who presented to the emergency department (ED) with ECG documented AF during 1 year prior to study commencement. The main purpose of Phase 1 is to determine if oral anticoagulants (OACs) were prescribed for eligible AF patients at ED discharge. In Phase 2 a low-intensity intervention will be applied in the ED during 6 months, involving physician education, distribution of an AF patient education package, short-term OAC prescription, and a follow-up letter to the patient's family physician. After a one month transition phase, a high intensity intervention will be applied during 6 months in Phase 3. Phase 3 incorporates the Phase 2 intervention, and adds immediate follow-up (within 48-72 hours) in a community AF clinic run by a nurse/pharmacist who is supervised by a specialist in AF.

Conditions

Interventions

  • Retrospective review of OAC prescription Other
    ARM 1: Kind: Experimental
    Label: Phase 1: Retrospective Chart Review
    Description: Retrospective chart review of all patients who presented to the emergency department (ED) with ECG-documented AF during 1 year prior to study commencement. The main purpose of Phase 1 is to determine if oral anticoagulants were prescribed for eligible AF patients at ED discharge.
  • Prescription of OAC in ED Other
    ARM 1: Kind: Experimental
    Label: Phase 2: Low-Intensity Intervention
    Description: Low-intensity intervention will be applied in the ED during 6 months, involving physician education, distribution of an AF patient education package, short-term oral anticoagulant prescription, and a follow-up letter to the patient's family physician.
    ARM 2: Kind: Experimental
    Label: Phase 3: High-Intensity Intervention
    Description: Phase 3 incorporates the Phase 2 intervention, and adds immediate follow-up (within 48-72 hours) in a community AF clinic run by a nurse/pharmacist who is supervised by a specialist in AF.
    ARM 3: Kind: Experimental
    Label: Phase 2: Low-Intensity Intervention
    Description: Low-intensity intervention will be applied in the ED during 6 months, involving physician education, distribution of an AF patient education package, short-term oral anticoagulant prescription, and a follow-up letter to the patient's family physician.
    ARM 4: Kind: Experimental
    Label: Phase 3: High-Intensity Intervention
    Description: Phase 3 incorporates the Phase 2 intervention, and adds immediate follow-up (within 48-72 hours) in a community AF clinic run by a nurse/pharmacist who is supervised by a specialist in AF.
  • Community AF clinic Other
    ARM 1: Kind: Experimental
    Label: Phase 3: High-Intensity Intervention
    Description: Phase 3 incorporates the Phase 2 intervention, and adds immediate follow-up (within 48-72 hours) in a community AF clinic run by a nurse/pharmacist who is supervised by a specialist in AF.
    ARM 2: Kind: Experimental
    Label: Phase 3: High-Intensity Intervention
    Description: Phase 3 incorporates the Phase 2 intervention, and adds immediate follow-up (within 48-72 hours) in a community AF clinic run by a nurse/pharmacist who is supervised by a specialist in AF.

Trial Design

  • Allocation: Non-Randomized
  • Masking: Open Label
  • Purpose: Prevention
  • Endpoint: Efficacy Study
  • Intervention: Single Group Assignment

Outcomes

Type Measure Time Frame Safety Issue
Primary New OAC Prescription (Phase 1 and 3 comparison) 6 months No
Secondary New OAC Prescription (Phase 1 and 2 comparison) 6 months No
Secondary New OAC Prescription (Phase 2 and 3 comparison) 6 months No
Secondary OAC use in eligible patients at 30 days 30 days No
Secondary OAC use in eligible patients at 6 months 6 months No
Secondary OAC use in eligible patients at 30 days (Phase 2 and 3 comparison) 30 days No
Secondary OAC use in eligible patients at 6 months (Phase 2 and 3 comparison) 6 months No
Secondary Uptake of study interventions 6 months No

Sponsors