Effectiveness of an algorithm-based care pathway for patients with non-valvular atrial fibrillation presenting to the emergency department.

Autor: Masica A; Center for Clinical Effectiveness Baylor Scott & White Health Dallas Texas USA.; Texas Health Resources Arlington Texas USA., Brown R; Center for Clinical Effectiveness Baylor Scott & White Health Dallas Texas USA.; UChicago Medicine Chicago Illinois USA., Farzad A; Texas A&M College of Medicine Dallas Texas USA.; Department of Emergency Medicine Baylor University Medical Center Dallas Texas USA., Garrett JS; Texas A&M College of Medicine Dallas Texas USA.; Integrative Emergency Services Dallas Texas USA., Wheelan K; Baylor Heart and Vascular Hospital Dallas Dallas Texas USA., Nguyen HL; Center for Clinical Effectiveness Baylor Scott & White Health Dallas Texas USA.; Department of Population and Quantitative Health Sciences University of Massachusetts School of Medicine Worcester Massachusetts USA., Ogola GO; Baylor Scott & White Research Institute Dallas Texas USA., Kudyakov R; Center for Clinical Effectiveness Baylor Scott & White Health Dallas Texas USA., McDonald B; Center for Clinical Effectiveness Baylor Scott & White Health Dallas Texas USA., Boyd B; Pfizer Inc. New York New York USA., Patel A; Pfizer Inc. New York New York USA., Delaughter C; Baylor Heart and Vascular Hospital Fort Worth Fort Worth Texas USA.
Jazyk: angličtina
Zdroj: Journal of the American College of Emergency Physicians open [J Am Coll Emerg Physicians Open] 2022 Feb 18; Vol. 3 (1), pp. e12608. Date of Electronic Publication: 2022 Feb 18 (Print Publication: 2022).
DOI: 10.1002/emp2.12608
Abstrakt: Objective: Atrial fibrillation (AF) carries substantial morbidity and mortality. Evidence-based guidelines have been synthesized into emergency department (ED) AF care pathways, but the effectiveness and scalability of such approaches are not well established. We thus evaluated the impacts of an algorithmic care pathway for ED management of non-valvular AF (EDAFMP) on hospital use and care process measures.
Methods: We deployed a voluntary-use EDAFMP in 4 EDs (1 tertiary hospital, 1 cardiac hospital, 2 community hospitals) of an integrated delivery organization using a multifaceted implementation approach. We compared outcomes between patients with AF treated using the EDAFMP and historical and contemporaneous "usual care" controls, using a propensity-score adjusted generalized estimating equation. Patients with an index ED encounter for a primary visit reason of non-valvular AF (and no excluding concurrent diagnoses) were eligible for inclusion.
Results: Preimplementation (January 1, 2016-December 31, 2016), 628 AF patients were eligible; postimplementation (September 1, 2017-June 30, 2019), 1296, including 271 (20.9%) treated with the EDAFMP, were eligible. EDAFMP patients were less likely to be admitted than both historical (adjusted odds ratio [aOR], 95% confidence interval [CI]: 0.45, 0.29-0.71) and contemporaneous controls (aOR, 95%CI: 0.63, 0.46-0.86). ED visits and hospital readmissions over 90 days subsequent to index ED encounters were similar between postimplementation EDAFMP and usual care groups. EDAFMP patients were more likely to be prescribed anticoagulation (38% v. 5%, P  < 0.001) and be referred to a cardiologist (93% vs 29%, P  < 0.001) versus the comparator group.
Conclusion: EDAFMP use is associated with decreased hospital admission during an index ED encounter for non-valvular AF, and improved delivery of AF care processes.
(© 2022 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)
Databáze: MEDLINE
Externí odkaz: