Abstract 12996: Prospective Study of Patient Reported Outcomes and Costs Associated With Same Day Discharge and Vascular Closure for Atrial Fibrillation Ablation

Abstract

Introduction: Overnight stay after ablation for atrial fibrillation (AF) is standard practice, in part driven by the need for bedrest required to maintain hemostasis. We aimed to measure patient reported outcomes (PROs) and costs associated with same day discharge (SDD) for AF ablation and vascular closure device implantation in clinical practice. Methods: PROs were measured in 50 patients prospectively enrolled prior to AF ablation with post procedure treatment by complete vascular device closure (n=25) versus compression hemostasis (n=25). Health-system costs for SDD patients receiving vascular device closure were compared to matched controls with one-night stays who did not receive closure devices. Results: Patients receiving vascular device closure for AF ablation had mean age 65, 17% female, with mean CHA 2 DS 2 -VASc score 3. Mean number of venous sheaths was higher among patients receiving vascular device closure (3.8 vs. 3.1, p<0.001), and there was 1 case of re-bleeding in a patient receiving vascular closure device (no other vascular complications). Same-day discharge rates (76% vs. 8.3%, p<0.001), patient satisfaction with bedrest time (8.5 vs. 6, p=0.004) and with pain (8 vs. 5.1, p=0.009) were significantly higher among patients receiving vascular closure. For health-system costs, patients with vascular closure the mean age was 66, 36% were female, with a mean CHA 2 DS 2 -VASc score of 2 (p=NS for each vs. matched controls). SDD with vascular closure was associated with significantly lower facility, pharmacy, and disposable costs, but higher implant costs ( Table ). Overall costs for ablation were not different based on conservative estimates for overnight stay costs. Conclusions: Vascular closure for AF ablation improves patient experience in routine clinical care. Use of vascular closure and SDD after AF ablation reduces several components of health system costs, without an overall increase, and may be cost-saving in comparative healthcare systems.