Key result
Delayed cardioversion links to ~79% more acute heart failure versus early cardioversion with similar inpatient mortality.
Why the study?
Data on clinical outcomes comparing delayed cardioversion to early cardioversion in patients with paroxysmal atrial fibrillation remained limited.
Does delayed cardioversion improve inpatient clinical outcomes compared to early cardioversion in hospitalized patients with paroxysmal atrial fibrillation?
Observational (n=17,879)
Yes
Does delayed cardioversion improve inpatient clinical outcomes compared to early cardioversion in hospitalized patients with paroxysmal atrial fibrillation?
Odds Ratio: 0.81 (95% CI 0.52–1.25)
p-value: p=0.76
In patients hospitalized with paroxysmal atrial fibrillation, delayed cardioversion is associated with increased risk of acute heart failure and greater resource utilization compared to early cardioversion, without any difference in mortality or stroke.
Delayed cardioversion was associated with more acute HF and resource use; leaves open whether timing causally affects outcomes in PAF.
Introduction: Data on clinical outcomes of Delayed Cardioversion (DCV) compared to Early Cardioversion (ECV) in patients with paroxysmal atrial fibrillation (PAF) remains limited. Hypothesis: Is there a difference in clinical outcomes between both procedures? Methods: We used the National Inpatient Sample database by utilizing ICD-10 codes to identify all hospitalizations with a diagnosis of PAF and cardioversion (CV) (2015-2020). The associations between the time of CV and outcomes were examined using multivariable logistic or generalized linear model regression. Propensity-score matched (PSM) analysis was utilized to determine adjusted odds ratio (aOR) of major clinical outcomes. Results: A total of 17,879 patients with PAF were included: 9,725 (54.4%) and 8,154 (45.6%) underwent ECV and DCV, respectively. Regarding inpatient mortality, there was no significant difference between both groups (aOR 0.81 [0.52-1.25], p=0.76). Considering cardiovascular outcomes, DCV was more associated with acute heart failure (AHF) (aOR 1.79 [1.67-1.92], p<0.01) with no significant difference in cardiac arrest (aOR 1.16 [0.73-1.84], p=0.38), cardiogenic shock (aOR 0.83 [0.59-1.17], p=0.97), need for permeant pacemaker (aOR 1.18 [0.91-1.54], p= 0.13), and arrhythmias (supraventricular and ventricular tachycardia) (aOR 0.97 [0.86-1.10], p=0.98) compared to ECV. As to neurological outcomes, there was no difference between both groups including transient ischemic attack (aOR 1.58 [0.82-3.04], p=0.12), ischemic stroke (aOR 1.06 (0.59-1.90), p=0.77), and hemorrhagic stroke (aOR 1.35 [0.36-5.07], p=0.45). Compared to ECV, DCV was associated with a higher median length of stay (4 days vs. 2 days, p<0.01) and cost of hospitalization ($33,410 vs. $21,738, p<0.01). Conclusions: Compared to ECV, DCV was associated with more AHF and resource utilization without significant differences in inpatient mortality and other major cardiovascular and neurological outcomes.
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Mohamed et al. (2023) conducted an observational in Paroxysmal Atrial Fibrillation (n=17,879). Delayed Cardioversion vs. Early Cardioversion was evaluated on Inpatient mortality (aOR 0.81, 95% CI 0.52-1.25, p=0.76). Delayed cardioversion was associated with more acute heart failure (aOR 1.79) and resource utilization compared to early cardioversion, with no difference in inpatient mortality (aOR 0.81; p=0.76).
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