A prospective, randomized, controlled trial of an emergency department-based atrial fibrillation treatment strategy with low-molecular-weight heparin

Michael H. Kim, Fred Morady, Barbara Conlon, Steven Kronick, Mark Lowell, David Bruckman, William F. Armstrong, Kim A. Eagle

Research output: Contribution to journalArticle

Abstract

Study objective: We assess an alternative accelerated clinical pathway approach to the management of patients with newly diagnosed or new-onset atrial fibrillation (AF). Methods: A prospective, randomized pilot study of 2 AF disease-management strategies was conducted at a single university hospital. A traditional approach of hospital admission versus an accelerated emergency department-based strategy with low-molecular-weight heparin and early cardioversion to sinus rhythm was assessed in a cohort of patients with uncomplicated AF. The primary end points were length of stay and total actual direct costs. Results: Eighteen patients were randomized over a 15-month period. The accelerated treatment strategy in the ED resulted in a substantial decrease in length of stay (2.1±2.3 versus >1 day) and a favorable trend toward mean cost reduction ($1,706±$1,512 versus $879±$394; P=.15). The clinical outcomes (rate of sinus rhythm at discharge and follow-up and complications caused by AF) related to AF were similar in the 2 groups. Conclusion: A disease-management strategy for new, uncomplicated AF that uses an ED-outpatient treatment pathway results in a shorter length of stay at potentially lower cost. The results of this pilot study warrant further investigation.

Original languageEnglish (US)
Pages (from-to)187-192
Number of pages6
JournalAnnals of Emergency Medicine
Volume40
Issue number2
DOIs
Publication statusPublished - Jan 1 2002
Externally publishedYes

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All Science Journal Classification (ASJC) codes

  • Emergency Medicine

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