Abstract 16802: Economics and Outcomes of Sotalol and Dofetilide In-Patient Dosing Approaches in Patients With Atrial Fibrillation

Abstract

Background: Inpatient initiation of sotalol (STL) and dofetilide (DFL) for patients with symptomatic atrial fibrillation (AF) can be variable, more so for STL. Objective: Define the impact of inpatient initiation of STL and DFL approaches on patient in-hospital costs and outcomes. Methods: AF patients that were admitted for STL (n=133) or DFL (n=38) initiation at an Intermountain Healthcare Hospital in 2018 were included to provide contemporary insight. Patient and dosing characteristics were described descriptively, and the impact of dosing schedule was correlated with daily hospital costs and outcomes. The CMS reimbursement for 3-day initiation of STL or DFL is $9,263.51. Results: The average age of the complete population was 69.7±11.7 years and 64.3% were male. Baseline risk factors were similar between groups. Mean ejection fraction was 59.2±8.9% and median QTc was 455.7±38.5 ms before STL dosing and 453.7±37.6 before DFL dosing. The average length of stay was 3.7±4.2 days and was shorter for DFL (3.0±2.0) compared to the STL (3.9±4.6). Within the DFL group, most received 5-6 doses, whereas STL dosing frequency was variable (Figure A). DFL discharge dose in 22 (57%) was 500 mcg BID and 125 mcg BID in 8 (21%). STL dose was 80 mg BID in 96 (72.1%) and 40 mg BID in 29 (21.8%). Total costs per hospitalization and per day were higher for STL compared to DFL (Figure B). QTc prolongation >500 ms was more common with DFL versus STL and other long-term outcomes were similar (Figure C). A 24 load of IV sotalol result in a cost savings of $871.55 vs. a 2-day load and $3,803.10 vs. a 3-day oral load. Conclusion: Routine contemporary inpatient STL dosing is markedly variable and results in the potential of both cost gain and loss to a hospital. Under dosing of STL is also common and may negatively impact long-term outcomes.