Opportunistic Screening for Atrial Fibrillation With Continuous ECG Monitoring in the Emergency Department Quiz

John is a 74-year-old male with hypertension and type 2 diabetes presenting to the emergency department for evaluation of chest pain. He has no prior history of atrial fibrillation and is currently on lisinopril 20 mg daily and metformin 1000 mg twice daily. Continuous ECG monitoring during his ED stay reveals episodes of atrial fibrillation lasting over 30 seconds, but he is discharged without a documented AF diagnosis or anticoagulation therapy. He has a CHA2DS2-VASc score of 4.

As a pharmacist reviewing John’s discharge medications, what is the most appropriate recommendation based on the study findings regarding his undiagnosed atrial fibrillation?

Maria is a 68-year-old Hispanic female with no known cardiac history presenting to the ED with palpitations. She is uninsured and does not have a primary care provider. Continuous ECG monitoring reveals paroxysmal atrial fibrillation lasting 45 seconds. Her CHA2DS2-VASc score is 3. She is discharged without AF documentation or anticoagulation therapy.

Considering the study’s findings on demographic disparities, what is a key pharmacist intervention to improve Maria’s care?

David, a 79-year-old male with a history of congestive heart failure and prior stroke, presents to the ED for evaluation of dizziness. Continuous ECG monitoring detects atrial fibrillation lasting 1 minute. His CHA2DS2-VASc score is 6. He is currently on aspirin 81 mg daily but no anticoagulation. The ED physician is uncertain about initiating anticoagulation at discharge.

Based on the study and current guidelines, what is the pharmacist’s best recommendation regarding anticoagulation for David?