Delayed vs early cardioversion in patients with paroxysmal atrial fibrillation: a population-based study (2015-2020)

Area of Science:

• Cardiology
• Inpatient Medicine
• Health Services Research

Background:

• Limited data exists comparing clinical outcomes of delayed cardioversion (DCV) versus early cardioversion (ECV) in patients with paroxysmal atrial fibrillation (AF).
• Understanding these differences is crucial for optimizing patient management and resource allocation in AF treatment.

Purpose of the Study:

• To compare the clinical outcomes of DCV versus ECV in a large cohort of paroxysmal AF patients.
• To identify potential disparities in acute heart failure, length of stay, cost, and mortality between the two cardioversion strategies.

Main Methods:

• A propensity-score matched analysis was conducted using data from the National Inpatient Sample (NIS) database from 2015 to 2020.
• The study included 17,879 patients with AF, with 9725 undergoing ECV and 8154 undergoing DCV.
• Adjusted odds ratios (aOR) were calculated for major clinical outcomes.

Main Results:

• DCV was associated with significantly higher odds of acute heart failure (AHF) compared to ECV (aOR 1.79; p < 0.01).
• Patients undergoing DCV experienced a longer median length of stay (4 days vs. 2 days; p < 0.01) and higher hospitalization costs ($33,410 vs. $21,738; p < 0.01).
• No significant differences were found in inpatient mortality or other cardiovascular and neurological outcomes between ECV and DCV groups.

Conclusions:

• Delayed cardioversion in paroxysmal AF patients is linked to increased rates of acute heart failure.
• DCV is also associated with greater resource utilization, including longer hospital stays and higher costs.
• These findings suggest that ECV may be a more favorable strategy in terms of both clinical outcomes and healthcare resource management for selected AF patients.