Affiliation:
1. Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
2. Department of Emergency Medicine Brigham and Women's Hospital Boston MA
3. Cardiology Division Massachusetts General Hospital Boston MA
4. Department of Emergency Medicine Massachusetts General Hospital Boston MA
5. Heart and Vascular Center Brigham and Women's Hospital Boston MA
Abstract
Background
Variability in the management of atrial fibrillation (
AF
) in the emergency department (
ED
) leads to avoidable hospital admissions and prolonged length of stay (
LOS
). In a retrospective single‐center study, a multidisciplinary
AF
treatment pathway was associated with a reduced hospital admission rate and reduced
LOS
. To assess the applicability of the
AF
pathway across institutions, we conducted a 2‐center study.
Methods and Results
We performed a prospective, 2‐stage study at 2 tertiary care hospitals. During the first stage,
AF
patients in the
ED
received routine care. During the second stage,
AF
patients received care according to the
AF
pathway. The primary study outcome was hospital admission rate. Secondary outcomes included
ED LOS
and inpatient
LOS
. We enrolled 104 consecutive patients in each stage. Patients treated using the
AF
pathway were admitted to the hospital less frequently than patients who received routine care (15% versus 55%;
P
<0.001). For admitted patients, average hospital
LOS
was shorter in the
AF
pathway cohort than in the routine care cohort (64 versus 105 hours, respectively;
P
=0.01). There was no significant difference in the average
ED LOS
between
AF
pathway and routine care cohorts (14 versus 12 hours, respectively;
P
=0.32).
Conclusions
In this prospective 2‐stage, 2‐center study, utilization of a multidisciplinary
AF
treatment pathway resulted in a 3.7‐fold reduction in admission rate and a 1.6‐fold reduction in average hospital
LOS
for admitted patients. Utilization of the
AF
pathway was not associated with a significant change in
ED LOS
.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
17 articles.
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