The next step is to determine if the recommended strategy is being used to reduce stroke risk. For patients with a CHADS2 score of 0, stroke risk is low, and recommendations include either no treatment or aspirin (75-325 mg /day). For a CHADS2 of 1, either oral anticoagulation with warfarin (to INR 2-3) or using a new oral anticoagulant (or aspirin) is recommended. For patients with a CHADS2 of 2 or more, an oral anticoagulant (i.e., warfarin or new oral anticoagulants) is recommended.

For patients who do not appear optimally managed, the next step is to notify the patient that their risk of stroke may not be optimally managed, and refer them to their personal physician flagging the potential opportunity for optimizing stroke prevention. In the emergency department, it is not our job to manage stroke risk in afib, but we should play a role in identifying and referring afib patients at risk for stroke who may not be on the right preventive treatment.

For more information about emergencey department patients and stroke risk, listen to the Oct. 24

Urgent Matters webinar: http://urgentmatters.org/webinars. ACEP and Urgent Matters also have a toolkit for providers and patients on the topic. You can find these at www.acep.org/afib.

Dr. Pines is director of the Office for Clinical Practice Innovation and a professor of emergency medicine and health policy at George Washington University.