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ED Care of AF & Hospital Charges

ED Care of AF & Hospital Charges

The initial management of newly recognized atrial fibrillation and atrial flutter (AF) lasting over 48 hours is generally heart rate control along with anticoagulation to prevent future embolic events. Once rate control is achieved by emergency physicians, decisions on the timing of the rhythm control are often left to admission cardiologists. For cases in which AF duration is shorter than 48 hours, patients are often managed similarly. Recent studies, however, show that many of these patients can benefit from ED cardioversion (EDCV) to achieve normal sinus rhythm with discharge from the ED to home. Potential for Significant Savings In a study published in the Western Journal of Emergency Medicine, my colleagues and I examined 300 AF patients who came to the ED for care and were screened for timing of symptom onset. EDCV was considered if nursing or physician notes documented onset of AF symptoms within 48 hours of ED presentation in patients younger than 85. The median charges for EDCV patients were $5,460, compared with $23,202 for those admitted with no attempt at cardioversion. Median charges for patients whose final ED rhythm was normal were $5,641; for those remaining in AF, median charges were $30,299. A surprising finding from our study was that the resource savings produced by simply attempting EDCV, regardless of the results, were also significant. Admitted patients remaining in AF following cardioversion attempts still had hospital charges that were $8,628 lower than those admitted with no EDCV attempt. Efficient & Effective The longer a heart remains in AF, the more the atrium becomes conditioned to accept this rhythm. The sooner after the onset of AF...

Weekend Vs Weekday Admissions for AF

A review of more than 86,000 discharges with a primary diagnosis of atrial fibrillation (AF) sug­gests that patients admitted on weekends appear to be less likely to undergo a cardioversion procedure and more likely to die resulting from AF when compared with patients admitted on weekdays. Cardioversion procedures were performed in 7.6% of AF patients during weekend admissions, compared with 16.2% for those being admitted during weekdays. The in-hospital mortality odds ratio was 1.23 for AF patients admitted during weekends. Abstract: American Journal of Cardiology, July 15,...

Managing Recent-Onset Atrial Fibrillation in the ED

Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance. AF is a risk factor for ischemic stroke and heart failure, both of which represent significant public health problems. With an increasing prevalence among an aging population, symptomatic AF-related ED visits have been rising and will likely continue to rise. Traditionally, ED patients thought to have recent-onset AF have been hospitalized for monitoring and evaluation of more serious conditions. More recently, clinicians have been utilizing a more aggressive approach in which stable ED patients with presumed recent-onset AF are treated with elective cardioversion without anticoagulation. While previous reports suggest that this approach is associated with a high rate of cardioversion to sinus rhythm and a low rate of hospitalization and complications, there is no consensus on whether it is better than traditional approaches. Seeking Confirmation on Recent-Onset AF Treatment In the February 2012 Journal of Emergency Medicine, David R. Vinson, MD, and colleagues published a prospective multicenter study that describes the management of ED patients with presumed recent-onset AF. “It had been our anecdotal experience at three affiliated community EDs that taking an aggressive cardioversion approach to managing patients with recent-onset AF was effective and associated with few complications,” says Dr. Vinson. “In this study, we put our practice patterns under critical scrutiny to confirm the safety and effectiveness of ED cardioversion and to accurately measure the incidence of thromboembolism 30 days after discharge.” “Clinicians who are already practicing a more aggressive approach to restoring sinus rhythm can be reassured by the safety and efficacy that was observed in our study.” Dr. Vinson and colleagues analyzed 206 patients...
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