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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...
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