Key result
Implementing an ED AF decision aid is linked to ~17% fewer hospital admissions.
Why the study?
A decision aid was developed to guide emergency department disposition of patients with AF, but its implementation in the ED had not been studied.
Does the implementation of an atrial fibrillation decision aid care pathway reduce hospital admissions in patients presenting to the emergency department with atrial fibrillation?
Observational (n=11,458)
Yes
Does the implementation of an atrial fibrillation decision aid care pathway reduce hospital admissions in patients presenting to the emergency department with atrial fibrillation?
Implementation of an ED decision aid for atrial fibrillation significantly reduced hospital admissions but was associated with a small increase in 30-day ED return visits.
Answers are grounded in this paper and cite their sources.
ED AF decision aid was associated with fewer admissions; leaves open need for randomized trials confirming safety amid higher returns.
BACKGROUND: A straightforward decision aid to guide disposition of atrial fibrillation (AF) patients in the emergency department (ED) was developed for use by ED providers. The implementation of this decision aid in the ED has not been studied. METHODS: A pragmatic stepped-wedge cluster approach for analysis of retrospectively collected electronic health record data was used in which 5 hospitals were selected to commence the intervention at periodic intervals following an initial 1-year baseline assessment with 5 additional hospitals included in the comparison group (all in North Carolina). The primary end point of analysis was hospitalization rate. Hierarchical multivariable logistic regression analyses for admission as a function of the intervention while controlling for prespecified patient and hospital predictors were performed with clustering done at the hospital level. RESULTS: Between October 2017 and May 2020, a total of 11 458 patients (mean age, 71.4; 50.5% female) presented to 1 of the 10 hospitals with a primary diagnosis of AF. Absolute admission rate was reduced from 60.5% to 48.3% following the intervention (odds ratio, 0.83 [95% CI, 0.71–0.97]; P =0.016). After adjusting for covariates, the intervention was associated with a small increased rate of return to the ED for AF within 30 days of the initial presentation (1.6% to 2.7%; hazard ratio, 1.70 [95% CI, 1.26–2.31]; P <0.001). CONCLUSIONS: We demonstrate that implementation of a novel decision aid to guide disposition of patients primary diagnosis of AF presenting to the ED was associated with a reduced admission rate independent of patient and hospital factors. Use of the protocol was associated with a small but significant increase in rate of repeat presentations for AF at 30-day follow-up. Use of a decision aid such as the one described here represents an important tool to reduce unnecessary AF hospitalizations.
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Gehi et al. (2023) conducted an observational in Atrial fibrillation (n=11,458). Atrial fibrillation decision aid care pathway vs. Usual care (baseline/comparison hospitals) was evaluated on Hospitalization rate (OR 0.83, 95% CI 0.71-0.97, p=0.016). Implementation of an atrial fibrillation decision aid in the emergency department reduced the absolute hospital admission rate from 60.5% to 48.3% (OR 0.83; 95% CI 0.71-0.97; P=0.016).
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