NuRse-led home CardiovErsion for control of atrial fibrillation-RACE 6.

BACKGROUND

Hospital care shifted to home may contribute to sustainability of health care. It is uncertain if home-based electrical cardioversion (ECV) is feasible.

METHODS

RACE‑6 is a prospective proof-of-concept pilot study on feasibility of ECV of persistent symptomatic atrial fibrillation (AF) at patient's homes. It is performed by a mobile nurse-led team, including an emergency care practitioner (ECP) and a sedation nurse, and is remotely supervised by a cardiologist with an ambulance (driver) standby. To ensure safe ECV, the ECP assessed the patients' homes beforehand for accessibility, hygiene, adequate space and light, electrical interference and explosive sources, electricity network stability, and the presence of an adequate informal caregiver overnight.

RESULTS

Six consenting patients with an uneventful previous in-hospital ECV for persistent AF developed one or two symptomatic recurrences and underwent in total 8 separate ECV attempts under conscious sedation at their homes. In all patients sinus rhythm returned and there were no early or late complications. Patients invariably preferred home cardioversion over cardioversion in-hospital.

DISCUSSION

Although applied in highly selected patients, home cardioversion may be extended to a wider selection of patients with persistent AF or even to patients with paroxysmal AF in need of acute restoration of sinus rhythm. Shortening time to cardioversion and early restoration of sinus rhythm may enhance patients' quality of life and postpone AF progression. Home cardioversion may appear safe and improve cost-effectiveness of care but randomized controlled trials are needed to show that home cardioversion may keep AF patients out of the hospital and contribute to the sustainability of health care.

CONCLUSION

Cardioversion at home is feasible and is generally well received by patients.