A prospective, randomized, controlled trial of an emergency department-based atrial fibrillation treatment strategy with low-molecular-weight heparin.
OBJECTIVE
We assess an alternative accelerated clinical pathway approach to the management of patients with newly diagnosed or new-onset atrial fibrillation (AF).


METHODS
A prospective, randomized pilot study of 2 AF disease-management strategies was conducted at a single university hospital. A traditional approach of hospital admission versus an accelerated emergency department-based strategy with low-molecular-weight heparin and early cardioversion to sinus rhythm was assessed in a cohort of patients with uncomplicated AF. The primary end points were length of stay and total actual direct costs.


RESULTS
Eighteen patients were randomized over a 15-month period. The accelerated treatment strategy in the ED resulted in a substantial decrease in length of stay (2.1+/-2.3 versus <1 day) and a favorable trend toward mean cost reduction ($1,706+/-$1,512 versus $879+/-$394; P =.15). The clinical outcomes (rate of sinus rhythm at discharge and follow-up and complications caused by AF) related to AF were similar in the 2 groups.


CONCLUSIONS
A disease-management strategy for new, uncomplicated AF that uses an ED-outpatient treatment pathway results in a shorter length of stay at potentially lower cost. The results of this pilot study warrant further investigation.
Division of Cardiology, Evanston Northwestern Healthcare, Evanston, IL 60201, USA. mhkim@northwestern.edu
Michael H
MH
Kim
Fred
F
Morady
Barbara
B
Conlon
Steven
S
Kronick
Mark
M
Lowell
David
D
Bruckman
William F
WF
Armstrong
Kim A
KA
Eagle
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000628:therapy; D003131:Combined Modality Therapy; D019091:Critical Pathways; D017985:Dalteparin / Q000627:therapeutic use*; D019468:Disease Management; D004554:Electric Countershock; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies
D000925:Anticoagulants; D017985:Dalteparin