• Michael H Kim, Fred Morady, Barbara Conlon, Steven Kronick, Mark Lowell, David Bruckman, William F Armstrong, and Kim A Eagle.
• Division of Cardiology, Evanston Northwestern Healthcare, Evanston, IL 60201, USA. mhkim@northwestern.edu
• Ann Emerg Med. 2002 Aug 1; 40 (2): 187-92.

Study ObjectiveWe assess an alternative accelerated clinical pathway approach to the management of patients with newly diagnosed or new-onset atrial fibrillation (AF).MethodsA 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.ResultsEighteen 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.ConclusionA 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.

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