Key result
The Emergency Department Atrial Fibrillation Management Pathway decreased the likelihood of hospital admission during an index encounter for non-valvular atrial fibrillation compared to contemporaneous usual care (aOR 0.63).
Why the study?
Evidence-based guidelines have been synthesized into emergency department AF care pathways, but the effectiveness and scalability of such approaches are not well established.
Does an algorithmic care pathway reduce hospital admissions and improve care processes in patients with non-valvular atrial fibrillation presenting to the emergency department?
Observational (n=1,924)
Yes
Does an algorithmic care pathway reduce hospital admissions and improve care processes in patients with non-valvular atrial fibrillation presenting to the emergency department?
Odds Ratio: 0.63 (95% CI 0.46–0.86)
Absolute Event Rate: 12.9% vs 31.6%
p-value: p=<0.001
Implementation of an algorithmic care pathway for non-valvular AF in the ED was associated with reduced hospital admissions and improved guideline-directed care processes such as anticoagulation prescription and cardiology referral.
May support ED AF pathways to reduce admissions; hypothesis-generating pending randomized confirmation of safety.
Objective Atrial fibrillation (AF) carries substantial morbidity and mortality. Evidence-based guidelines have been synthesized into emergency department (ED) AF care pathways, but the effectiveness and scalability of such approaches are not well established. We thus evaluated the impacts of an algorithmic care pathway for ED management of non-valvular AF (EDAFMP) on hospital use and care process measures. Methods We deployed a voluntary-use EDAFMP in 4 EDs (1 tertiary hospital, 1 cardiac hospital, 2 community hospitals) of an integrated delivery organization using a multifaceted implementation approach. We compared outcomes between patients with AF treated using the EDAFMP and historical and contemporaneous “usual care” controls, using a propensity-score adjusted generalized estimating equation. Patients with an index ED encounter for a primary visit reason of non-valvular AF (and no excluding concurrent diagnoses) were eligible for inclusion. Results Preimplementation (January 1, 2016–December 31, 2016), 628 AF patients were eligible; postimplementation (September 1, 2017–June 30, 2019), 1296, including 271 (20.9%) treated with the EDAFMP, were eligible. EDAFMP patients were less likely to be admitted than both historical (adjusted odds ratio [aOR], 95% confidence interval [CI]: 0.45, 0.29–0.71) and contemporaneous controls (aOR, 95%CI: 0.63, 0.46–0.86). ED visits and hospital readmissions over 90 days subsequent to index ED encounters were similar between postimplementation EDAFMP and usual care groups. EDAFMP patients were more likely to be prescribed anticoagulation (38% v. 5%, P < 0.001) and be referred to a cardiologist (93% vs 29%, P < 0.001) versus the comparator group. Conclusion EDAFMP use is associated with decreased hospital admission during an index ED encounter for non-valvular AF, and improved delivery of AF care processes.
No takes yet. Share an insight, caveat, or question.
Masica et al. (2022) conducted an observational in Non-valvular atrial fibrillation (n=1,924). Emergency Department Atrial Fibrillation Management Pathway (EDAFMP) vs. Usual care was evaluated on Hospital admission during the index ED encounter (aOR 0.63, 95% CI 0.46-0.86, p=<0.001). The Emergency Department Atrial Fibrillation Management Pathway decreased the likelihood of hospital admission during an index encounter for non-valvular atrial fibrillation compared to contemporaneous usual care (aOR 0.63).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: