Same-Day Discharge After AF Abalation: Evaluating Outcomes

Same-day discharge after atrial fibrillation (AF) ablation was found to be safe and effective, according to study results published in Heart Lung and Circulation.

A same-day discharge protocol after AF ablation may help minimize health care resources.

In this retrospective single-center cohort study, the data of 3054 patients (27.2% women) who underwent AF ablation between 2010 and 2014 were examined.  The study’s primary efficacy outcome was the proportion of patients who were discharged on the day they received AF ablation, and the primary safety outcome was a composite of death, stroke/transient ischemic attack or embolism, and bleeding requiring hospitalization occurring within 30 days after discharge. A healthcare utilization outcome was also examined, which considered hospital readmission for any reason within 30 days of ablation.

A total of 2418 patients (79.2%) were discharged on the day they received AF ablation. The most common reasons for admission were late procedure finish (n=152; 23.9%), access site bleeding (n=145; 22.8%), intraprocedural complications (n=64; 10.1%), and multiple concerns excluding complications (n=124; 19.5%). Procedural complications were most strongly associated with reduced likelihood for same day discharge (odds ratio [OR], 0.002; 95% CI, 0.001-0.008).

The 30-day readmission rate in this cohort was 8.4%. The highest rate of readmission was observed in patients who were initially admitted for a procedural complication (readmission rate, 19.5%). The readmission rate of patients who received same day discharge was 7.7% compared with 10.2% for patients who were initially admitted (P =.055). The most common cause for readmission was AF or related arrhythmia (n=134; 47.0%).

Patients who were initially admitted experienced higher rates of readmission whether they had intraprocedural complications (OR, 3.12; 95% CI, 1.72-5.66) or not (OR, 1.44; 95% CI, 1.03-2.01).

The overall rate of the composite safety outcome was 0.43%, which did not include intraprocedural complications identified during the index ablation procedure. The highest risk for complications was observed in patients with initial admission for procedural complication (2.60%; P =.044 for comparison with same-day discharge). Bleeding (n=8; 0.26%) was the most common component of the safety outcome, which occurred almost exclusively in the same-day discharge group (n=7).

The investigators noted that the observational nature of the study may have introduced a bias in the determination of patients who received same-day discharge.

“Same-day discharge after AF ablation is feasible in the majority of patients using a standardized protocol,” the study authors concluded. “This approach was not associated with higher 30-day hospital readmission or complications after discharge.”

Disclosure: Dr. Deyell and Dr. Sikkel reported affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.

Reference

Reddy SA, Nethercott SL, Chattopadhyay R, Heck PM, Virdee MS. Safety, feasibility and economic impact of same-day discharge following atrial fibrillation ablation [published online April 8, 2020]. Heart Lung Circ. doi:10.1016/j.hlc.2020.02.016