AF Clinic Reduces Hospital Admissions, Saves Money

May 08, 2014

MELBOURNE, AUSTRALIA — An ambulatory outpatient clinic that specializes in the treatment of patients with atrial fibrillation (AF) can help significantly reduce the number of patients admitted to the hospital, reduce hospital lengths of stay, and lower costs, according to the results of a single-center study.

Of the patients managed by the specialized clinic, the majority were successfully discharged to their general practitioner, while 13% were further referred to the hospital cardiology service for follow-up.

"This is all about keeping the patient out of the hospital," said Rashid.

The results of study, conducted at an academic medical center in the UK, were presented this week at the World Congress of Cardiology 2014 Scientific Sessions by Dr Muhammad Rashid (Aintree University Hospital, Liverpool, UK). Speaking with heartwire , Rashid said that more and more patients are presenting to the emergency department with complications arising from AF. In the past five years, their center has seen a 33% increase in hospitalizations, often triggered by a need for rate control or even just anticoagulation.

To combat the increase in hospitalizations, Rashid and colleagues established a specialized AF clinic that is affiliated with the hospital. It is staffed seven days per week during workday hours by three nurses specialized in the management of AF. He stressed it is not an anticoagulation service. Instead, patients with AF who present to the emergency department are referred to the specialized clinic if they are hemodynamically stable and do not possess other comorbidities driving the AF. Patients who are not stable or those with social/mobility problems that would prevent them from returning to the clinic are excluded.

At the clinic, the case of each patient is discussed with the attending cardiologist. Once a decision has been made regarding the appropriate treatment strategy—rate or rhythm control—care is supervised by the nurses in the ambulatory clinic. Patients are then discharged by the nurses and asked to return to the clinic the next day, where they are seen by the cardiologist to ensure they are in rate or rhythm control. Rashid said there is no established protocol for return visits to the clinic, but this is left to the discretion of the nurse and physician.

Nearly 1200 patients since 2011 have come through the ambulatory clinic. Most of the patients seen by the clinic were treated with rate control, and 260 patients underwent DC cardioversion to normal sinus rhythm.

Roughly one-third of the patients were discharged the same day and not admitted to the hospital. Of the remaining two-thirds of patients seen by the clinic and admitted to the hospital, approximately 33% were discharged within 48 hours. There were no major adverse cardiovascular events. Of those sent home the same day, just 12 patients were readmitted to the hospital within 30 days. In total, 87% of patients managed by the specialized clinic were referred back to their family physician, while 13% were referred to the cardiology service for further treatment.

By stratifying hemodynamically stable patients to the AF clinic, the average length of hospital stay for patients presenting to the emergency department has been reduced significantly, said Rashid. He estimates the clinic has saved approximately 5600 in-hospital bed stays. The pilot program first began with just one specialized nurse but has been expanded to three nurses when the hospital realized the cost savings. In the two years the program has been running, approximately £2.4 million (US $4 million) have been saved.

"The main purpose for setting up the service was to provide a safe environment for the effective management of atrial fibrillation patients and also to facilitate early discharge," he said.

Rashid reports no conflicts of interest.

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