Key result
Institution-specific dofetilide protocol is linked to a ~0.6-night shorter hospital stay vs standard initiation.
Why the study?
Does an institution-specific dofetilide initiation protocol reduce hospital length of stay and cost in patients admitted for dofetilide initiation?
Observational (n=150)
No
Does an institution-specific dofetilide initiation protocol reduce hospital length of stay and cost in patients admitted for dofetilide initiation?
Effect estimate: Difference 0.56 nights (95% CI 0.20-0.92)
Absolute Event Rate: 2.35% vs 2.91%
p-value: p=0.0029
Implementation of a condensed dosing protocol for dofetilide initiation significantly reduces hospital length of stay and associated costs.
May support shorter stays for dofetilide initiation; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Dofetilide is a class III antiarrhythmic drug indicated for the conversion and maintenance of normal sinus rhythm in symptomatic patients with atrial fibrillation/atrial flutter. Delay in initiation of dofetilide therapy may increase the duration of hospitalization from two nights to three nights to complete US Food and Drug Administration-required monitoring. Therefore, substantial cost savings may be associated with implementation of an institution-specific dofetilide initiation protocol in order to reduce hospitalization to two nights. This could potentially be achieved through protocol-defined utilization of the option for a condensed dosing interval for the first three doses of dofetilide in order to ensure the administration of two doses on the first day of hospitalization. OBJECTIVE: The primary objective of this study was to assess the impact of an institution-specific dofetilide initiation protocol on mean hospital length of stay and cost for dofetilide initiation. METHODS: The study design was a retrospective review of 150 patients admitted to the Clement J. Zablocki Veterans Affairs Medical Center for the purpose of dofetilide initiation. Matching time periods of 18 months before and after implementation of the institution-specific dofetilide initiation protocol were used to randomly select 75 patients from each time period for comparison. RESULTS: A significant reduction in mean hospital length of stay of 0.56 nights post-implementation of the institution-specific dofetilide initiation protocol was identified (95% confidence interval 0.20-0.92; P = 0.0029). Assuming hospital adjusted expenses per inpatient day of US$1831-2413, a reduction in hospital length of stay of 0.56 nights resulted in estimated cost savings of US$1025-1351 per admission for dofetilide initiation. CONCLUSION: Implementation of an institution-specific dofetilide initiation protocol decreases mean hospital length of stay and cost for dofetilide initiation.
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Kennedy et al. (2018) conducted an observational in Atrial fibrillation/atrial flutter (n=150). Institution-specific dofetilide initiation protocol vs. Pre-protocol implementation (standard initiation) was evaluated on Mean hospital length of stay (nights) (Difference 0.56 nights, 95% CI 0.20-0.92, p=0.0029). Implementation of an institution-specific dofetilide initiation protocol significantly reduced mean hospital length of stay by 0.56 nights compared to standard initiation.
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