Atrial Fibrillation Treatment Pathway in the Emergency Department Reduces Median 30-Day Health Service Charges.

Abstract

Background: The economic burden of atrial fibrillation (AF) continues to increase. AF treatment pathways have been shown to reduce avoidable admissions, but the effects on health care costs are not understood. This study sought to assess the impact of an AF treatment pathway on health service charges and emergency department (ED) discharge rates.

Methods: An AF treatment pathway was implemented at 7 hospital EDs in North Carolina between 2017 and 2020. Thirty-day health service charges were calculated for ED visits, hospitalizations, and outpatient clinic appointments. A quasi-experimental design was used to assess changes in health service charges and ED discharge rates following implementation of the AF treatment pathway. Adjusted quantile and negative binomial regressions were used to analyze changes in median 30-day health service charges and discharge rates from the ED, respectively.

Results: Among 12 504 patients that met eligibility for study inclusion (preperiod: n=3893; postperiod: n=8611), implementation of the AF treatment pathway significantly reduced 30-day health service charges (preperiod: $11 922; postperiod: $9219; P<0.001). In adjusted models, implementation of the AF treatment pathway was associated with an $834 decrease in median 30-day health service charges (95% CI, -$1630 to $-37; P=0.04). Additionally, the adjusted predicted probability of ED discharge increased from 65.3% to 70.0% after the AF treatment pathway implementation, a 4.7 percentage point increase (95% CI, 1.4-8.0; P<0.001).

Conclusions: The implementation of an AF treatment pathway in the ED was associated with a decrease in median 30-day health service charges and an increase in ED discharge rate for patients presenting with AF.