Cardiology Division, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Intermountain Medical Center Heart Institute, Murray, Utah, USA.
J Cardiovasc Electrophysiol. 2022 Mar;33(3):333-342. doi: 10.1111/jce.15342. Epub 2022 Jan 5.
There exists variability in the administration of in-patient sotalol therapy for symptomatic atrial fibrillation (AF). The impact of this variability on patient in-hospital and 30-day posthospitalization costs and outcomes is not known. Also, the cost impact of intravenous sotalol, which can accelerate drug loading to therapeutic levels, is unknown.
One hundred and thirty-three AF patients admitted for oral sotalol initiation at an Intermountain Healthcare Hospital from January 2017 to December 2018 were included. Patient and dosing characteristics were described descriptively and the impact of dosing schedule was correlated with daily hospital costs/clinical outcomes during the index hospitalization and for 30 days. The Centers for Medicare and Medicaid Services reimbursement for 3-day sotalol initiation is $9263.51. Projections of cost savings were made considering a 1-day load using intravenous sotalol that costs $2500.00 to administer.
The average age was 70.3 ± 12.3 years and 60.2% were male with comorbidities of hypertension (83%), diabetes (36%), and coronary artery disease (53%). The mean ejection fraction was 59.9 ± 7.8% and the median corrected QT interval was 453.7 ± 37.6 ms before sotalol dosing. No ventricular arrhythmias developed, but bradycardia (<60 bpm) was observed in 37.6% of patients. The average length of stay was 3.9 ± 4.6 (median: 2.2) days. Postdischarge outcomes and rehospitalization rates stratified by length of stay were similar. The cost per day was estimated at $2931.55 (1. $2931.55, 2. $5863.10, 3. $8794.65, 4. $11 726.20).
In-patient oral sotalol dosing is markedly variable and results in the potential of both cost gain and loss to a hospital. In consideration of estimated costs, there is the potential for $871.55 cost savings compared to a 2-day oral load and $3803.10 compared to a 3-day oral load.
在因有症状的心房颤动（房颤）而住院的患者中，索他洛尔的治疗方式存在差异。但这种差异对患者住院期间和出院后 30 天的成本和结果的影响尚不清楚。此外，静脉注射索他洛尔（可加速药物达到治疗水平）的成本影响也尚不清楚。
纳入了 2017 年 1 月至 2018 年 12 月期间在 Intermountain Healthcare 医院因口服索他洛尔起始治疗而住院的 133 名房颤患者。对患者和剂量特征进行描述性分析，并将剂量方案的影响与住院期间和出院后 30 天的每日住院费用/临床结果进行相关性分析。使用 3 天索他洛尔的医疗保险和医疗补助服务中心报销费用为 9263.51 美元。考虑到使用静脉注射索他洛尔进行 1 天负荷治疗，其治疗费用为 2500.00 美元，因此做出了成本节约的预测。
患者平均年龄为 70.3±12.3 岁，60.2%为男性，合并症包括高血压（83%）、糖尿病（36%）和冠状动脉疾病（53%）。平均射血分数为 59.9±7.8%，在开始索他洛尔治疗前校正的 QT 间期中位数为 453.7±37.6ms。没有出现室性心律失常，但 37.6%的患者出现了心动过缓（<60bpm）。平均住院时间为 3.9±4.6 天（中位数：2.2 天）。按住院时间分层的出院后结局和再住院率相似。每天的费用估计为 2931.55 美元（1. 2931.55 美元，2. 5863.10 美元，3. 8794.65 美元，4. 11726.20 美元）。
住院患者口服索他洛尔的剂量存在明显差异，这可能导致医院的成本增加或减少。考虑到估计成本，与 2 天的口服负荷相比，可能节省 871.55 美元的成本，与 3 天的口服负荷相比，可能节省 3803.10 美元的成本。
