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Efficacy and Safety of Same-Day Discharge for Atrial Fibrillation Ablation
Marc W Deyell1, Richard A Leather2, Laurent Macle3
1Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Same-day discharge after atrial fibrillation (AF) ablation is feasible for most patients using a standardized protocol. This approach did not increase hospital readmission or complication rates post-discharge.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Catheter ablation for atrial fibrillation (AF) is a common procedure.
- Increasing AF ablation volumes strain hospital resources.
- A same-day discharge protocol was developed to manage these demands.
Purpose of the Study:
- To evaluate the efficacy of a same-day discharge protocol for AF ablation.
- To assess health care utilization associated with this protocol.
- To determine the safety of same-day discharge after AF ablation.
Main Methods:
- A multicenter cohort study included 3,054 patients undergoing AF ablation from 2010 to 2014.
- Primary outcomes included successful same-day discharge, 30-day hospital readmission, and a composite safety endpoint.
- Safety endpoint comprised 30-day death, stroke/TIA/embolism, or bleeding requiring hospitalization.
Main Results:
- Same-day discharge was achieved in 79.2% of patients.
- 30-day readmission rates were 7.7% for same-day discharge vs. 10.2% (no complications) and 19.5% (with complications).
- Post-discharge complication rates were low and similar across groups (0.37% for same-day discharge).
Conclusions:
- A standardized same-day discharge protocol is feasible for the majority of AF ablation patients.
- This approach does not lead to increased hospital readmission rates.
- Same-day discharge was not associated with higher complication rates after the initial procedure.
Objectives:
The purpose of this study was to evaluate the efficacy, health care utilization, and safety of a same-day discharge protocol.
Background:
Catheter ablation of atrial fibrillation (AF) is the most common ablation performed. Increasing volumes of AF ablation are placing demands on hospital resources. In response, our institutions developed a same-day discharge protocol for AF ablation.
Methods:
This was a multicenter cohort study of all patients undergoing AF ablation from 2010 to 2014 at 2 major centers. The primary efficacy outcome was the proportion of successful same-day discharges. The primary health care utilization outcome was 30-day hospital readmission for any reason. The primary safety outcome was a composite of 30-day death, stroke/transient ischemic attack or embolism, or bleeding requiring hospitalization.
Results:
A total of 3,054 patients underwent AF ablation from 2010 to 2014 and met inclusion criteria. Same-day discharge was achieved in 79.2% (2,418 of 3,054). Hospital readmission at 30 days was 7.7% for the same-day discharge group, 10.2% for those who remained in the hospital overnight without complications (p = 0.055 for comparison with same-day discharge), and 19.5% (p < 0.001) for those who remained in the hospital with procedural complications (7.7%). Complication rates from discharge to 30 days (excluding immediate procedural complications) were 0.37% for the same-day discharge group, 0.36% (p = 0.999) for those kept overnight without complications, and 2.5% (p = 0.044) for those with initial procedural complications.
Conclusions:
Same-day discharge after AF ablation is feasible in the majority of patients with use of a standardized protocol. This approach was not associated with higher hospital readmission or complication rates after discharge.
