title: Impact of a practice guideline for patients with atrial fibrillation on medical resource utilization and costs.
abstract: Health care resource utilization is high for patients presenting with acute atrial fibrillation (AF). The potential for treatment algorithms to safely reduce resource consumption in this setting has not been prospectively evaluated. We designed and implemented a practice guideline for the management of patients presenting to the emergency department (ED) with the primary diagnosis of AF, with emphasis on appropriate cardioversion, use of oral rate-controlling medications, and expedited referral to an outpatient AF clinic. We prospectively collected clinical and resource utilization data on all such patients for 14 months before and after institution of the guideline. Institution of the guideline was associated with a decreased rate of hospital admission (from 74% to 38%), with no differences in ED return visits or hospital readmission within 30 days. No strokes or deaths were observed. This large decrease in resource utilization during the intervention phase of the study translated to an average decrease in 30-day total direct health care costs of approximately $1,400 US dollars per patient. Our clinical and cost outcomes were minimally affected after statistical adjustment for baseline differences between study groups. We conclude that the implementation of our practice guideline was feasible, safe, and effective. Widespread adoption of such practices may have large financial implications for the health care system.
authors.affiliation: Division of Cardiology, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA. pzimetba@caregroup.harvard.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Zimetbaum
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Reynolds
authors.forename: Kalon K L
authors.initials: KK
authors.lastname: Ho
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaziano
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: McDonald
authors.forename: Seth
authors.initials: S
authors.lastname: McClennen
authors.forename: Ronna
authors.initials: R
authors.lastname: Berezin
authors.forename: Mark E
authors.initials: ME
authors.lastname: Josephson
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001281:Atrial Fibrillation / Q000191:economics* / Q000628:therapy*; D004632:Emergency Medical Services / Q000191:economics* / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000592:standards; D006295:Health Resources / Q000191:economics* / Q000592:standards*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards; D011446:Prospective Studies; D013997:Time Factors