A prospective, randomized, controlled trial of an emergency department–based atrial fibrillation treatment strategy with low-molecular-weight heparin

Study objective: We assess an alternative accelerated clinical pathway approach to the management of patients with newly diagnosed or new-onset atrial fibrillation (AF). Methods: A prospective, randomized pilot study of 2 AF disease-management strategies was conducted at a single university hospital. A traditional approach of hospital admission versus an accelerated emergency department–based strategy with low-molecular-weight heparin and early cardioversion to sinus rhythm was assessed in a cohort of patients with uncomplicated AF. The primary end points were length of stay and total actual direct costs. Results: Eighteen patients were randomized over a 15-month period. The accelerated treatment strategy in the ED resulted in a substantial decrease in length of stay (2.1±2.3 versus <1 day) and a favorable trend toward mean cost reduction ($1,706±$1,512 versus $879±$394; P=.15). The clinical outcomes (rate of sinus rhythm at discharge and follow-up and complications caused by AF) related to AF were similar in the 2 groups. Conclusion: A disease-management strategy for new, uncomplicated AF that uses an ED-outpatient treatment pathway results in a shorter length of stay at potentially lower cost. The results of this pilot study warrant further investigation. [Kim MH, Morady F, Conlon B, Kronick S, Lowell M, Bruckman D, Armstrong WF, Eagle KA. A prospective, randomized, controlled trial of an emergency department–based atrial fibrillation treatment strategy with low-molecular-weight heparin. Ann Emerg Med. August 2002;40:187-192.]