Impact of an Emergency Department Observation Unit Management Algorithm for Atrial Fibrillation

Abstract

BackgroundAtrial fibrillation (AF) is a common, growing, and costly medical condition. We aimed to evaluate the impact of a management algorithm for symptomatic AF that used an emergency department observation unit on hospital admission rates and patient outcomes.Methods and ResultsThis retrospective cohort study compared 563 patients who presented consecutively in the year after implementation of the algorithm, from July 2013 through June 2014 (intervention group), with 627 patients in a historical cohort (preintervention group) who presented consecutively from July 2011 through June 2012. All patients who consented to have their records used for chart review were included if they had a primary final emergency department diagnosis of AF. We observed no significant differences in age, sex, vital signs, body mass index, or CHADS2 (congestive heart failure, hypertension, age, diabetes mellitus, and prior stroke or transient ischemic attack) score between the preintervention and intervention groups. The rate of inpatient admission was significantly lower in the intervention group (from 45% to 36%; P<0.001). The groups were not significantly different with regard to rates of return emergency department visits (19% versus 17%; P=0.48), hospitalization (18% versus 16%; P=0.22), or adverse events (2% versus 2%; P=0.95) within 30 days. Emergency department observation unit admissions were 40% (P<0.001) less costly than inpatient hospital admissions of ≤1 day's duration.ConclusionsImplementation of an emergency department observation unit AF algorithm was associated with significantly decreased hospital admissions without increasing the rates of return emergency department visits, hospitalization, or adverse events within 30 days.

Observation Status or Inpatient Admission: Impact of Patient Disposition on Outcomes and Utilization Among Emergency Department Patients With Chest Pain

“…Many institutions have developed outpatient observation units, with 36% of US EDs reporting having observation units in 2007. Multiple studies have demonstrated that use of observation for a limited time in dedicated units can provide equivalent quality care at lower cost than inpatient care for select conditions including toxicology, skin infections, chest pain, syncope, atrial fibrillation, heart failure, and abdominal pain . Unfortunately we were not able to evaluate observation units separated from observations performed in other areas of the hospital and not dependent from the ED.…”

Emergency Department Visits for Atrial Fibrillation in the United States: Trends in Admission Rates and Economic Burden From 2007 to 2014

“…Published data support these new paradigms as safe and logistically feasible alternatives to inpatient management of appropriately selected patients with AF 11, 12, 13, 14, 15. The implementation of these strategies has been shown to result in substantial reductions in hospital admission rates and costs 13, 14, 15. However, studies describing these new approaches are relatively small, and the guidelines for management of AF in the ED are not as well validated or widely adopted as other aspects of AF management 26, 27.…”

“…This includes early assessment and cardioversion, followed by a brief observation period, and subsequent discharge of stable patients from the ED. Published data support these new paradigms as safe and logistically feasible alternatives to inpatient management of appropriately selected patients with AF 11, 12, 13, 14, 15. The implementation of these strategies has been shown to result in substantial reductions in hospital admission rates and costs 13, 14, 15.…”

“…The annual cost of AF treatment was estimated to be $6.65 billion in 2005,7 and later estimates were even higher 10. Intervention programs at the emergency department (ED) level have been investigated and successfully implemented in some academic centers in recent years to reduce the hospitalization rates for AF and their associated costs 11, 12, 13, 14, 15…”

The Values of Coronary Circulating miRNAs in Patients with Atrial Fibrillation

“…Despite the fact that the pathophysiology of atrial fibrillation (AF) has been investigated extensively for almost a century, the underlying mechanisms remain only partially understood [1–5]. Conventional theories have focused on electrical and structural remodeling [6].…”