Implementation of an Atrial Fibrillation Decision Aid Care Pathway in the Emergency Department Reduces Atrial Fibrillation Hospitalizations-Reference-Cited by-同舟云学术

Implementation of an Atrial Fibrillation Decision Aid Care Pathway in the Emergency Department Reduces Atrial Fibrillation Hospitalizations

Published:2023-09 Issue:9 Volume:16 Page:
ISSN:1941-7713
Container-title:Circulation: Cardiovascular Quality and Outcomes
language:en
Short-container-title:Circ: Cardiovascular Quality and Outcomes

Author:

Gehi Anil K.¹^ORCID,Armbruster Tiffany¹,Walker Jennifer¹^ORCID,Rosman Lindsey¹^ORCID,Laux Jeffrey²^ORCID,Becker Ari¹,Aladesanmi Oludamilola¹^ORCID,Mazzella Anthony J.¹^ORCID,Deyo Zachariah³,Biese Kevin⁴

Affiliation:

1. Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill (A.G., T.A., J.W., L.R., A.B., O.A., A.J.M.).

2. University of North Carolina at Chapel Hill Gillings School of Global Public Health (J.L.).

3. Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, NC (Z.D.).

4. Department of Emergency Medicine, University of North Carolina at Chapel Hill (K.B.).

Abstract

BACKGROUND: A straightforward decision aid to guide disposition of atrial fibrillation (AF) patients in the emergency department (ED) was developed for use by ED providers. The implementation of this decision aid in the ED has not been studied. METHODS: A pragmatic stepped-wedge cluster approach for analysis of retrospectively collected electronic health record data was used in which 5 hospitals were selected to commence the intervention at periodic intervals following an initial 1-year baseline assessment with 5 additional hospitals included in the comparison group (all in North Carolina). The primary end point of analysis was hospitalization rate. Hierarchical multivariable logistic regression analyses for admission as a function of the intervention while controlling for prespecified patient and hospital predictors were performed with clustering done at the hospital level. RESULTS: Between October 2017 and May 2020, a total of 11 458 patients (mean age, 71.4; 50.5% female) presented to 1 of the 10 hospitals with a primary diagnosis of AF. Absolute admission rate was reduced from 60.5% to 48.3% following the intervention (odds ratio, 0.83 [95% CI, 0.71–0.97]; P =0.016). After adjusting for covariates, the intervention was associated with a small increased rate of return to the ED for AF within 30 days of the initial presentation (1.6% to 2.7%; hazard ratio, 1.70 [95% CI, 1.26–2.31]; P <0.001). CONCLUSIONS: We demonstrate that implementation of a novel decision aid to guide disposition of patients primary diagnosis of AF presenting to the ED was associated with a reduced admission rate independent of patient and hospital factors. Use of the protocol was associated with a small but significant increase in rate of repeat presentations for AF at 30-day follow-up. Use of a decision aid such as the one described here represents an important tool to reduce unnecessary AF hospitalizations.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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