Our Lady of Lourdes Medicine Center, Camden, New Jersey.
West J Emerg Med. 2013 Feb;14(1):55-7. doi: 10.5811/westjem.2012.1.6893.
Emergency department (ED) cardioversion (EDCV) and discharge of patients with recent onset atrial fibrillation or atrial flutter (AF) has been shown to be a safe and effective management strategy. This study examines the impact of such aggressive ED management on hospital charges.
A random sample of 300 AF patients were identified from an ED electronic data base and screened for timing of onset of their symptoms. Patients were considered eligible for EDCV if either nursing or physician notes documented an onset of symptoms less than 48 hours prior to ED presentation and the patient was less than 85 years of age. An explicit chart review was then performed to determine patient management and disposition. Cardioversion attempts were defined as ED administration of procainamide, flecainide, propafenone, ibutilide, amiodarone or direct current cardioversion (DCCV). Total hospital charges for each patient were obtained from the hospital billing office. Differences across medians were analyzed utilizing through Wilcoxon rank sum tests and chi square.
A total of 51 patients were included in the study. EDCV was attempted on 24 (47%) patients, 22 (92%) were successfully cardioverted to normal sinus rhythm (NSR). An additional 12 (23%) spontaneously converted to NSR. Twenty (91%) of those successfully cardioverted were discharged from the ED along with 4 (33%) of those spontaneously converting. Pharmacologic cardioverson was attempted in six patients and was successful in three (50%), one after failed DCCV attempt. Direct current cardioversion was attempted in 21 (88%) and was successful in 19 (90%), two after failed pharmacologic attempts. Median charges for patients cardioverted and discharged from the ED were $5,460 (IQR $4,677-$6,190). Median charges for admitted patients with no attempt at cardioversion were $23,202 (IQR $19,663-$46,877). Median charges for patients whose final ED rhythm was NSR were $5,641 (IQR $4,638-$12,339) while for those remaining inAF median charges were $30,299 (IQR $20,655 - $69,759).
ED cardioversion of recent onset AF patients results in significant hospital savings.
急诊部门（ED）的心房颤动或心房扑动（AF）复律（EDCV）和患者出院已被证明是一种安全有效的管理策略。本研究考察了这种积极的 ED 管理对医院费用的影响。
从 ED 电子数据库中随机抽取 300 名 AF 患者进行筛查，以确定其症状发作的时间。如果护理或医生的记录记录了症状发作在 ED 就诊前不到 48 小时，且患者年龄小于 85 岁，则认为患者符合 EDCV 的条件。然后进行明确的图表审查，以确定患者的管理和处置。复律尝试被定义为 ED 给予普罗卡因胺、氟卡尼、普罗帕酮、伊布利特、胺碘酮或直流电复律（DCCV）。从医院计费办公室获得每位患者的总住院费用。利用 Wilcoxon 秩和检验和卡方检验分析中位数之间的差异。
共有 51 名患者纳入研究。对 24 名（47%）患者进行了 EDCV 尝试，其中 22 名（92%）成功复律为窦性心律（NSR）。另外 12 名（23%）患者自发转为 NSR。20 名（91%）成功复律的患者从 ED 出院，4 名（33%）自发转律的患者出院。对 6 名患者进行了药物复律尝试，其中 3 名（50%）成功，1 名在 DCCV 尝试失败后成功。对 21 名（88%）患者进行了直流电复律尝试，其中 19 名（90%）成功，2 名在药物复律尝试失败后成功。从 ED 转律并出院的患者的中位费用为 5460 美元（IQR 4677-6190）。未尝试复律的住院患者的中位费用为 23202 美元（IQR 19663-46877）。最终 ED 节律为 NSR 的患者的中位费用为 5641 美元（IQR 4638-12339），而仍处于 AF 状态的患者的中位费用为 30299 美元（IQR 20655-69759）。
ED 对近期发作的 AF 患者进行复律可显著节省医院费用。
