35: Impact of Emergency Department Management of Atrial Fibrillation on Hospital Resource Utilization

Emergency department cardioversion (EDCV) and discharge of patients with recent onset atrial fibrillation or atrial flutter (AF) has been shown to be a safe and effective management strategy. This study examines the impact of such aggressive ED management on hospital resource utilization. A random sample of 300 AF patients were identified from an emergency department electronic database and screened for timing of onset of their symptoms. Patients were considered eligible for EDCV if their predominant baseline rhythm was Normal Sinus Rhythm (NSR) and either nursing or physician notes documented an onset of symptoms less than 48 hours prior to ED presentation. An explicit chart review was performed to determine patient management and disposition. Cardioversion attempatients were defined as ED administration of procainamide, flecanide, propafenone, ibutilide, amiodarone or Direct Current Cardioversion (DCCV). Total hospital charges for each patient were obtained from the hospital billing office and served as a surrogate for hospital resource utilization. Statistical analysis was through ANOVA. A total of 56 patients were included in the study. EDCV was attempted on 25 (44.6%) patients, 23 (92%) were successfully cardioverted to NSR. An additional 13 (23%) spontaneously converted to NSR. Twenty (86%) of those successfully cardioverted were discharged from the ED along with 4 (31%) of those spontaneously converting. Pharmacologic cardioverson was attempted in 6 patients and was successful in 3 (50%), 1 after failed DCCV attempt. Direct current cardioversion was attempted in 22 (88%) and was successful in 20 (91%), 2 after failed pharmacologic attempatients. Four admitted patients who did not undergo EDCV had hospital charges from $90,215 to $321,195 and were considered extreme outliers and excluded from the financial analysis. Mean hospital charges for patients successfully cardioverted and discharged from the ED were $5,457 compared with $25,198 for those admitted with no cardioversion attempted (p<0.001). Charges for patients whose final ED rhythm was NSR were $9,598 compared to $26,876 for those remaining in AF (p<0.001). Total hospital charges for patients based on EDCV attempt, final rhythm and disposition are contained in Table 1 (p<0.001).Tabled 1 Emergency department cardioversion of recent onset AF patients results in considerable savings of hospital resources.