Studies Reveal Progressive Treatment Approach for Atrial Fibrillation Yields Significant Benefits to Patients
Friday, May 18, 2012
The Emergency Department (ED) at Our Lady of Lourdes Medical Center is among a handful of EDs in the U.S. and the only emergency department in the state to use Emergency Department Cardioversion and Discharge (EDCD), a progressive treatment approach for patients with recent onset atrial fibrillation (Afib) in which a controlled electrical shock is delivered to the heart to restore its rhythm to a normal pattern in the setting of the ED.
At last week's 2012 Society of Academic Emergency Medicine (SAEM) Annual Meeting held in Chicago, a team of emergency department physicians and cardiologists from Lourdes presented data based on a year-and-a-half-long study involving more than 300 Afib patients managed under EDCD at the Our Lady of Lourdes Medical Center.
The study revealed that Afib can not only be managed successfully using EDCD, but that the approach provides considerable benefits to the patient including improved quality of life, quicker return to normal activities and reduced length of stay (87 percent of patients receiving EDCD in the study were discharged the same day). In addition, the team calculated the approach reduces costs associated with treatment for this condition.
This study is related to a prior study conducted at Lourdes in 2010, which concluded that immediate cardioversion eliminates the need for anticoagulation, reduces the risk of stroke for patients remaining in Afib and increases the chance of maintaining normal sinus rhythm post-discharge. Cost savings for these patients averaged near $20,000 by avoiding hospital admission.
Afib is considered the most common cardiac arrhythmia seen in emergency departments across the nation. Over 5 million Americans currently suffer from this condition and approximately
160,000 new patient cases arise each year. Treatment for Afib is highly individualized and determined based on the patient's medical history, physical examination and length of time experiencing symptoms. Cardioversion is considered a safe and effective treatment for eligible Afib patients.
Turnaround time in the emergency department can be as short as 30 minutes, but generally averages between 1.5 to 2 hours. Patients are sent home the same day as opposed to 3 days following traditional treatment methods, and can resume all normal activities after the cardioversion.
"The Emergency Department staff is so comfortable with EDCD that we allow family members to remain with the patient while we perform the cardioversion," notes Alfred Sacchetti, MD, Chief of Emergency Services at Our Lady of Lourdes Medical Center, who was also the first patient to undergo EDCD at Lourdes. "What is most impressive is how every patient undergoing this form of cardioversion comments on how simple and painless the procedure is and how much better it is than receiving medications and admission to the hospital." (A YouTube video demonstrating the procedure on a Lourdes patient in real time is available at http://www.youtube.com/watch?v=rSusgpskmzk).
"Having a team of cardiologists progressive enough to utilize EDCD is essential to the success of our program," continues Dr. Sacchetti. Lourdes cardiologists Steven Levi, MD, Devender Akula, MD and Darius Sholevar, MD, who specialize in the treatment of atrial fibrillation and other heart rhythm disturbances, are among only a handful of electrophysiologists who are employing EDCD, working in close collaboration with their colleagues in emergency medicine.
It is important to note that with EDCD, emergency department care only addresses the immediate atrial fibrillation event. Some patients with recurring episodes will require a more definitive treatment termed an "ablation" in which the portion of the heart that causes the rhythm disturbance is electrically silenced.
Our Lady of Lourdes Medical Center is one of the largest providers of cardiac services in the Delaware Valley region. It is ranked number one in the state of New Jersey, and among America's 100 Best Hospitals for heart care by HealthGrades