Delayed discharges due to initiation of warfarin in atrial fibrillation: a prospective audit.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. OBJECTIVE: The goal of this study was to determine whether initiation of warfarin treatment in patients with AF, while in thc hospital, is associated with an increased length of stay. METHODS: This was a prospective audit involving patients with AF newly started on warfarin while in the hospital. It was conducted in 3 acute medical wards (total, 96 beds) of a district general hospital. Patients were reviewed daily regarding the necessity of their hospital stay. Their stay was considered delayed if their original medical condition had resolved and their stay was attributed solely to initiation of warfarin to reach a therapeutic International Normalized Ratio (INR). The Barthel Index score was used to assess patients' activities of daily living. The medical teams treating these patients were unaware of the objective of the study. RESULTS: Over a 6-month period, 23 patients with AF (13 men, 10 women; mean [SD] age, 75.4 [9.2] years) were started on warfarin while in the hospital and thus comprised our study group. Of these 23 patients, 7 (30%) had delayed discharges that were solely attributed to initiation of warfarin. Total length of stay for all patients combined was 217 days; of these, 36 (17%) days were considered delayed discharges. Only 10 (43%) patients were discharged with their INR in the target range of 2 to 3. There was no significant difference between patients who had delayed discharges versus nondelayed discharges in terms of age, sex, number of comorbidities, number of medications, Barthel Index score, reason for admission, mean INR, number of patients achieving target INR on discharge, or main warfarin loading regimens. CONCLUSIONS: Initiation of warfarin in these patients with AF while in the hospital led to increased length of stay. A move toward starting anticoagulation in an outpatient setting could reduce length of hospital stay.