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Zylla MM, Imberti JF, Leyva F, Casado-Arroyo R, Braunschweig F, Pürerfellner H, Merino JL, Boriani G. Same-day discharge vs. overnight stay following catheter ablation for atrial fibrillation: a comprehensive review and meta-analysis by the European Heart Rhythm Association Health Economics Committee. Europace 2024; 26:euae200. [PMID: 39077807 PMCID: PMC11321359 DOI: 10.1093/europace/euae200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/25/2024] [Indexed: 07/31/2024] Open
Abstract
AIMS Same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) may address the growing socio-economic health burden of the increasing demand for interventional AF therapies. This systematic review and meta-analysis analyses the current evidence on clinical outcomes in SDD after AF ablation compared with overnight stay (ONS). METHODS AND RESULTS A systematic search of the PubMed database was performed. Pre-defined endpoints were complications at short-term (24-96 h) and 30-day post-discharge, re-hospitalization, and/or emergency room (ER) visits at 30-day post-discharge, and 30-day mortality. Twenty-four studies (154 716 patients) were included. Random-effects models were applied for meta-analyses of pooled endpoint prevalence in the SDD cohort and for comparison between SDD and ONS cohorts. Pooled estimates for complications after SDD were low both for short-term [2%; 95% confidence interval (CI): 1-5%; I2: 89%) and 30-day follow-up (2%; 95% CI: 1-4%; I2: 91%). There was no significant difference in complications rates between SDD and ONS [short-term: risk ratio (RR): 1.62; 95% CI: 0.52-5.01; I2: 37%; 30 days: RR: 0.65; 95% CI: 0.42-1.00; I2: 95%). Pooled rates of re-hospitalization/ER visits after SDD were 4% (95% CI: 1-10%; I2: 96%) with no statistically significant difference between SDD and ONS (RR: 0.86; 95% CI: 0.58-1.27; I2: 61%). Pooled 30-day mortality was low after SDD (0%; 95% CI: 0-1%; I2: 33%). All studies were subject to a relevant risk of bias, mainly due to study design. CONCLUSION In this meta-analysis including a large contemporary cohort, SDD after AF ablation was associated with low prevalence of post-discharge complications, re-hospitalizations/ER visits and mortality, and a similar risk compared with ONS. Due to limited quality of current evidence, further prospective, randomized trials are needed to confirm safety of SDD and define patient- and procedure-related prerequisites for successful and safe SDD strategies.
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Affiliation(s)
- Maura M Zylla
- Department of Cardiology, Heidelberg Center of Heart Rhythm Disorders, Medical University Hospital, Im Neuenheimer Feld 410, Heidelberg, Germany
- Health Economics Committee of EHRA (European Heart Rhythm Association)
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41121 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Francisco Leyva
- Health Economics Committee of EHRA (European Heart Rhythm Association)
- Aston Medical Research Institute, Aston Medical School, Aston University, Aston Triangle, B4 7ET Birmingham, UK
| | - Ruben Casado-Arroyo
- Health Economics Committee of EHRA (European Heart Rhythm Association)
- Department of Cardiology, H.U.B. Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Frieder Braunschweig
- Health Economics Committee of EHRA (European Heart Rhythm Association)
- Department of Medicine, Solna, Karolinska Institutet
- ME Cardiology, Karolinska University Hospital, Norrbacka S1:02, Eugeniavagen 27, 171 77 Stockholm, Sweden
| | - Helmut Pürerfellner
- Department of Cardiology, Public Hospital Elisabethinen, Academic Teaching Hospital, Ordensklinikum A-4020 Linz, Fadingerstraße 1, Austria
| | - José L Merino
- Arrhythmia-Robotic Electrophysiology Unit, La Paz University Hospital, IdiPAZ, Universidad Autonoma, Madrid, Spain
| | - Giuseppe Boriani
- Health Economics Committee of EHRA (European Heart Rhythm Association)
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41121 Modena, Italy
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König S, Wohlrab L, Leiner J, Pellissier V, Nitsche A, Darma A, Hilbert S, Nedios S, Seewöster T, Dinov B, Hindricks G, Bollmann A. Patient perspectives on same-day discharge following catheter ablation for atrial fibrillation: results from a patient survey as part of the monocentric FAST AFA trial. Europace 2023; 25:euad262. [PMID: 37656979 PMCID: PMC10492224 DOI: 10.1093/europace/euad262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/11/2023] [Indexed: 09/03/2023] Open
Abstract
AIMS Same-day discharge (SDD) following catheter ablation (CA) of atrial fibrillation (AF) was already introduced in selected facilities in Europe, but a widespread implementation has not yet succeeded. Data on patients' perspectives are lacking. Therefore, we conducted a survey to address patients' beliefs towards SDD and identify variables that are associated with their evaluation. METHODS AND RESULTS As part of the prospective, monocentric FAST AFA trial, patients aged ≥20 years undergoing left atrial CA for AF were asked to participate in the survey consisting of a study-specific questionnaire, the AF knowledge scale, and pre-defined patient-reported outcome measures. The study cohort was stratified based on SDD willingness, and a logistic regression analysis was used to identify predictors for patients' valuation. Between 26 July 2021 and 01 July 2022, 256 of 376 screened patients consented to study participation of whom 248 (mean age 61.8 years, 33.9% female) completed the SDD survey. Of them, 50.0% were willing to have SDD concepts integrated into their clinical course with increased patient comfort (27.5%), shorter waiting times (14.6%), and a cost-efficient treatment (14.0%) being imaginable benefits. In contrast, expressed concerns included uncertainties with occurring complaints (50.6%), the insufficient recognition (47.8%), and treatment (48.9%) of complications. European Heart Rhythm Association class at baseline and inpatient treatments within the preceding year were predictors for SDD willingness whereas comorbidity burden or AF knowledge were not. CONCLUSION We provide a detailed survey expressing patients' beliefs towards SDD following left atrial CA. Our findings may facilitate adequate patient selection to improve the future implementation of SDD programs in suitable cohorts.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Lisa Wohlrab
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Johannes Leiner
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Vincent Pellissier
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Anne Nitsche
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Angeliki Darma
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Timm Seewöster
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
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König S, Richter S, Bollmann A, Hindricks G. Safety and feasibility of same-day discharge following catheter ablation of atrial fibrillation: what is known and what needs to be explored? Herz 2022; 47:123-128. [PMID: 35257191 DOI: 10.1007/s00059-022-05102-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/25/2022]
Abstract
Catheter ablation of atrial fibrillation (AF) is the most effective rhythm control strategy and its role in the treatment of AF patients has been strengthened by recent guidelines. An increasing AF prevalence and the resulting demands on interventional electrophysiology call for improved resource allocation through both technical innovations and streamlined workflows and patient pathways. Same-day discharge is already established in the context of other electrophysiological interventions; however, its broad implementation in the practice of AF ablation is pending for several reasons, despite the fact that the body of evidence is growing and the majority of reports propagate early discharge to be feasible and safe under certain conditions. This review article is intended to provide an overview of the existing data, classify these into the specific study context, and to show limitations and open questions.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
- Leipzig Heart Institute, Leipzig, Germany.
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
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Bailey SA, Subramanian K, Sanchez J, P Horton R, Natale A, Thambidorai S. Same Day versus Overnight Discharge in Patients Undergoing Ablation for Atrial Fibrillation (SODA) Study. J Atr Fibrillation 2021; 14:20200499. [PMID: 34950374 DOI: 10.4022/jafib.20200499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/11/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022]
Abstract
Patients undergoing catheter ablation for atrial fibrillation (AF) are routinely admitted for observation overnight in the hospital. With the rising incidence of AF among the population, increased volumes of procedures are placing increased demands on hospital resources. The purpose of this study was to evaluate the efficacy and safety of same day discharge in patients undergoing ablation for AF when compared to patients admitted for overnight observation. We performed a retrospective analysis using a multicenter cohort among patients who were discharged home after elective pulmonary vein isolation (PVI) ablation for AF. In our analysis, we found no statistically significant difference between patients discharged on the day of their procedure when compared to patients admitted for overnight observation in terms of 90-day readmission, major adverse cardiovascular events and death. This study shows that same day discharge after AF ablation is a feasible option. Future studies are needed to elicit the appropriate protocol to use.
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Sahashi Y, Kuno T, Tanaka Y, Passman R, Briasoulis A, Malik AH. The 30-day readmission rate of same-day discharge protocol following catheter ablation for atrial fibrillation: a propensity score-matched analysis from National Readmission Database. Europace 2021; 24:755-761. [PMID: 34904164 DOI: 10.1093/europace/euab296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
AIMS The effectiveness and safety of same-day discharge (SDD) for catheter ablation (CA) for atrial fibrillation (AF) has not been fully elucidated using a large nationwide database. This study aimed to evaluate the all-cause readmission rates within 30-days among patients receiving CA for AF with an SDD protocol compared with a conventional overnight stay (ONS). METHODS AND RESULTS We performed a retrospective cohort study using the US Nationwide Readmission Database. The primary outcome was all-cause 30-day readmission following discharge in patients receiving CA and a secondary outcome was requiring total healthcare cost. A 1 : 3 propensity score matching was conducted to compare the safety and efficacy within both SDD and ONS group. Among 30 776 patients [mean 67.2 ± 11.4 years, 12 590 female (41.5%)] who received CA from 2016 through 2018, 440 (1.42%) patients were discharged on the same-day following CA (SDD group), and the remaining 30 336 patients stayed at least one night in the hospital (ONS group). A propensity score analysis generated 1751 matched pairs (440 in the SDD group; 1311 in the ONS group). The 30-day readmission following discharge was not significantly higher in the SDD group than the ONS group (SDD vs. ONS: 12.7% vs. 9.7%; hazard ratio: 1.17, 95% confidence interval: 0.76-1.81, P = 0.47). Healthcare cost was significantly higher in the ONS group ($25 237 ± 14 036 vs. $30 749 ± 16 383; P < 0.01). CONCLUSION In this nationwide database study, there was no significant difference in the all-cause 30-day readmission following SDD for CA compared with ONS.
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Affiliation(s)
- Yuki Sahashi
- Department of Cardiovascular Medicine, Gifu Heart Center, 4-14-4, Yabutaminami, Gifu 500-8384, Japan.,Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA.,Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Yoshihiro Tanaka
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rod Passman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Aaqib H Malik
- Division of Cardiology, Westchester Medical Center, Valhalla, NY, USA
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