TY - JOUR
T1 - A prospective, randomized, controlled trial of an emergency department-based atrial fibrillation treatment strategy with low-molecular-weight heparin
AU - Kim, Michael H.
AU - Morady, Fred
AU - Conlon, Barbara
AU - Kronick, Steven
AU - Lowell, Mark
AU - Bruckman, David
AU - Armstrong, William F.
AU - Eagle, Kim A.
PY - 2002/1/1
Y1 - 2002/1/1
N2 - 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.
AB - 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.
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U2 - 10.1067/mem.2002.126169
DO - 10.1067/mem.2002.126169
M3 - Article
C2 - 12140498
AN - SCOPUS:0036315754
VL - 40
SP - 187
EP - 192
JO - Annals of Emergency Medicine
JF - Annals of Emergency Medicine
SN - 0196-0644
IS - 2
ER -