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Same-day discharge following catheter ablation of atrial fibrillation: A safe and cost-effective approach
Antonio Creta1, Nicoletta Ventrella2, Rui Providência1
1Department of Electrophysiology, Barts Heart Center, St. Bartholomew's Hospital, London, UK.
Insights
Same-day discharge after atrial fibrillation (AF) ablation is safe and cost-effective. This strategy for AF catheter ablation shows a low complication rate and significant hospital cost savings.
Area of Science:
- Cardiology
- Medical Economics
Background:
- Catheter ablation for atrial fibrillation (AF) is increasingly common, straining healthcare resources.
- Same-day discharge may improve efficiency, but its safety requires further investigation.
Purpose of the Study:
- To evaluate the safety and cost-effectiveness of same-day discharge following AF catheter ablation.
- To assess early and 30-day post-discharge complication rates.
Main Methods:
- Retrospective analysis of 727 patients undergoing day-case AF ablation across two centers.
- Safety endpoint: complications and/or hospital presentation within 48 hours and 30 days.
- Economic analysis to determine potential cost savings.
Main Results:
- 1.8% of patients experienced complications within 48 hours, with 0.7% requiring hospitalization.
- Common readmissions included femoral access site bleeding (0.5%) and chest pain (0.5%).
- The overall 30-day complication rate was 3.7%, with significant annual cost savings of approximately £83,927.
Conclusions:
- Same-day discharge for selected AF ablation patients is a safe and cost-effective strategy.
- Low rates of early readmission and post-discharge complications support this approach.
- This policy enhances hospital efficiency and reduces healthcare costs.
Introduction:
The frequency of catheter ablation for atrial fibrillation (AF) has increased dramatically, stretching resources. Discharge on the same day as treatment may increase the efficiency and throughput. There are limited data regarding the safety of this strategy.
Methods:
We performed a retrospective analysis of consecutive patients undergoing AF ablation in a tertiary center and in a district general hospital, and identified those discharged on the same day of treatment. The safety endpoint was any complication and/or presentation to hospital in the 48-h and at 30 days postdischarge. We performed an economic analysis to calculate potential cost saving.
Results:
Among a total population of 2628 patients, we identified 727 subjects (61.1 ± 12.5 years, 69.6% male) undergoing day-case AF ablation. Cryoballoon technique was used in 79.2% of the day-cases, and 91.6% of the procedures were performed under conscious sedation. 1.8% (13) of the participants met the safety composite endpoint at 48-h, however only 0.7% (5) required at least 1 day of hospitalization. Bleeding or hematoma at the femoral access site (0.5%) and pericarditic chest pain (0.5%) were the main reasons for readmission. None experienced cardiac tamponade or other life-threatening complications in the 48-h postdischarge. Overall rate of complication and/or presentation to hospital at 30 days was 3.7%. Our day-case policy resulted in an annual cost-saving of approximately of £83 927 for our hospital.
Conclusion:
In this large multicentre cohort, same-day discharge in selected patients following AF ablation appears to be safe and cost-effective, with a very low rate of early readmission or post-discharge complication.
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