Same-day discharge for AF ablation feasible in most cases, not tied to readmission
Same-day discharge for patients who underwent atrial fibrillation ablation was feasible for most patients and was not associated with an increased risk for 30-day readmission, researchers reported.
Among the cohort, complication rates at 30 days were higher in patients kept overnight after their AF ablation due to procedural complications compared with patients discharged on the same day and patients kept overnight for reasons other than procedural complications.
“This study confirms that same-day discharge after atrial fibrillation ablation, done under general anesthetic, is very feasible and safe for the majority of patients,” Marc W. Deyell, MD, MSC, clinical assistant professor in the division of cardiology at the University of British Columbia, Canada, told Healio. “Notably, our same-day discharge protocol did not involve extra equipment or resources beyond usual post-procedure care. Thus, this protocol should be generalizable to other centers performing atrial fibrillation ablation.”
For the multicenter cohort study published in JACC: Clinical Electrophysiology, researchers in Canada assessed all patients who underwent AF ablation at St. Paul’s Hospital and Royal Jubilee Hospital between 2010 and 2014 (n = 3,054; mean age, 60 years; 27% women; 62% with paroxysmal AF; 38% with persistent AF). The primary efficacy outcome was successful same-day discharges; the primary health care utilization outcome was 30-day hospital readmission; and the primary composite safety outcome was 30-day death, stroke or transient ischemic attack, embolism or bleeding.
Readmission after same-day discharge
According to the researchers, same-day discharge was achieved in 79.2% of patients.
Readmission at 30 days was 7.7% among patients who were discharged the same day, 10.2% among patients who stayed overnight without complications (P vs. same-day discharge = .055), and 19.5% patients who remained in-hospital due to procedural complications (P vs. same-day discharge < .001).
According to the study, the highest rate of the composite safety outcome was among patients with index admission for complication (2.6%; P vs. same-day discharge = .044).
Among patients who were readmitted within 30 days, the most common cause was AF or related arrhythmias (47%), followed by HF or respiratory distress (11.3%) and chest pain or pericarditis (11.3%).
“As we had implemented same-day discharge for many years, we were not completely surprised by the data,” Deyell said in an interview. “However, we were surprised, and reassured, by the continued decrease in overall complication rates with contemporary atrial fibrillation ablation. This low complication rate gives us more confidence in continuing same-day discharge.”
The overall rate of the composite safety outcome was 0.43% at 30 days.
Investigators observed that the most prevalent component of the composite safety outcome was bleeding (0.26%), which was also the most common safety outcome in the same-day discharge group (0.29%).
“We did have a signal that emergency room admissions may be higher in patients who are discharged on the same day,” Deyell told Healio. “We are conducting a further analysis to look at ER visits in an updated cohort from Vancouver. Finally, we are also evaluating whether there is any difference in outcomes between patients treated with cryoballoon ablation vs. radiofrequency ablation.”
ED visits after same day discharge
In other findings, the same-day discharge group had a higher rate of ED visits compared with patients kept overnight after their ablation without an intraprocedural complication (19.3% vs. 9.4%; P = .167).
“Given that the most common reason for readmission for the entire cohort was recurrent AF or other atrial arrhythmias, consideration should be given to interventions, such as continuation of antiarrhythmics and enhanced patient education, to reduce readmissions to the hospital early after ablation,” Deyell and colleagues wrote.
Limitations to consider
In a related editorial, Sanjay Dixit, MD, director of cardiac electrophysiology at the Hospital of the University of Pennsylvania, highlighted several of the limitations of the study, including, “its retrospective observational design that allows for selection bias. Also, there was a lack of standardization in the patient management practices around the AF ablation procedure between the two participating sites. This is reflected in the use of transesophageal echocardiography almost universally at one center, which may have potentially delayed procedure start and finish times, leading to more admissions post-ablation at that site.
“Despite these limitations, this study has shown us that early discharge is feasible in the majority of AF patients undergoing catheter ablation,” Dixit wrote. “This should provide us the impetus and framework to further explore expeditious discharge strategies that can be applied to a more diverse population of AF patients across different health care systems.”
Reference:
Collapse