TY - JOUR
T1 - Impact of an Organized Treatment Pathway on Management of Atrial Fibrillation
T2 - The ER2EP Study
AU - Lakkireddy, Dhanunjaya
AU - Ahmed, Adnan
AU - Bawa, Danish
AU - Garg, Jalaj
AU - Atkins, Donita
AU - Kabra, Rajesh
AU - Pham, Nicholas
AU - Bernholtz, Jacelyn
AU - Darden, Douglas
AU - Bommana, Sudha
AU - Gopinathannair, Rakesh
AU - Pothineni, Naga Venkata K.
AU - Park, Peter
AU - Vasamreddy, Chandra
AU - Tummala, Rangarao
AU - Koerber, Scott
AU - Della Rocca, Domenico
AU - DiBiase, Luigi
AU - Al-Ahmad, Amin
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/5
Y1 - 2024/5
N2 - Background: Atrial fibrillation (AF) is the most common arrhythmia reported worldwide. There is significant heterogeneity in AF care pathways for a patient seen in the emergency room, impacting access to guideline-driven therapies. Objectives: The purpose of this study was to compare the difference in AF outcomes between those treated with an organized treatment pathway vs routine-care approach. Methods: The emergency room to electrophysiology service study (ER2EP) is a multicenter, prospective observational registry (NCT04476524) enrolling patients with AF from sites where a pathway for management of AF was put in place compared to sites where a pathway was not in place within the same health system and the same physicians providing services at all sites. Multivariable regression modeling was performed to identify predictors of clinical outcomes. Beta coefficient or odds ratio was reported as appropriate. Results: A total of 500 patients (ER2EP group, n = 250; control group, n = 250) were included in the study. The mean age was 73.4 ± 12.9 years, and 52.2% were males. There was a statistically significant difference in primary endpoint [time to ablation (56 ± 50.9 days vs 183.3 ± 109.5 days; P < 0.001), time to anticoagulation initiation (2.1 ± 1.6 days vs 19.7 ± 35 days, P < 0.001), antiarrhythmic drug initiation (4.8 ± 7.1 days vs 24.7 ± 44.4 days, P < 0.001) compared to the control group, respectively. As such, this resulted in reduced length of stay in the ER2EP group compared to the control group (2.4 ± 1.4 days vs 3.23 ± 2.5 days, P = 0.002). Conclusions: This study provides evidence that having an organized pathway from the emergency department for AF patients involving electrophysiology services can improve early access to definitive therapies and clinical outcomes.
AB - Background: Atrial fibrillation (AF) is the most common arrhythmia reported worldwide. There is significant heterogeneity in AF care pathways for a patient seen in the emergency room, impacting access to guideline-driven therapies. Objectives: The purpose of this study was to compare the difference in AF outcomes between those treated with an organized treatment pathway vs routine-care approach. Methods: The emergency room to electrophysiology service study (ER2EP) is a multicenter, prospective observational registry (NCT04476524) enrolling patients with AF from sites where a pathway for management of AF was put in place compared to sites where a pathway was not in place within the same health system and the same physicians providing services at all sites. Multivariable regression modeling was performed to identify predictors of clinical outcomes. Beta coefficient or odds ratio was reported as appropriate. Results: A total of 500 patients (ER2EP group, n = 250; control group, n = 250) were included in the study. The mean age was 73.4 ± 12.9 years, and 52.2% were males. There was a statistically significant difference in primary endpoint [time to ablation (56 ± 50.9 days vs 183.3 ± 109.5 days; P < 0.001), time to anticoagulation initiation (2.1 ± 1.6 days vs 19.7 ± 35 days, P < 0.001), antiarrhythmic drug initiation (4.8 ± 7.1 days vs 24.7 ± 44.4 days, P < 0.001) compared to the control group, respectively. As such, this resulted in reduced length of stay in the ER2EP group compared to the control group (2.4 ± 1.4 days vs 3.23 ± 2.5 days, P = 0.002). Conclusions: This study provides evidence that having an organized pathway from the emergency department for AF patients involving electrophysiology services can improve early access to definitive therapies and clinical outcomes.
KW - antiarrhythmic drugs
KW - atrial fibrillation
KW - electrophysiology service
KW - emergency room
KW - hospitalization
KW - length of stay
KW - oral anticoagulation
KW - organized treatment pathway
KW - radiofrequency ablation
KW - stroke
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U2 - 10.1016/j.jacadv.2024.100905
DO - 10.1016/j.jacadv.2024.100905
M3 - Article
AN - SCOPUS:85188233628
SN - 2772-963X
VL - 3
JO - JACC: Advances
JF - JACC: Advances
IS - 5
M1 - 100905
ER -