Same-day discharge vs. overnight stay following catheter ablation for atrial fibrillation: a comprehensive review and meta-analysis by the European Heart Rhythm Association Health Economics Committee.
Europace
; 26(8)2024 Aug 03.
Article
em En
| MEDLINE
| ID: mdl-39077807
ABSTRACT
AIMS:
Same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) may address the growing socio-economic health burden of the increasing demand for interventional AF therapies. This systematic review and meta-analysis analyses the current evidence on clinical outcomes in SDD after AF ablation compared with overnight stay (ONS). METHODS ANDRESULTS:
A systematic search of the PubMed database was performed. Pre-defined endpoints were complications at short-term (24-96â h) and 30-day post-discharge, re-hospitalization, and/or emergency room (ER) visits at 30-day post-discharge, and 30-day mortality. Twenty-four studies (154 716 patients) were included. Random-effects models were applied for meta-analyses of pooled endpoint prevalence in the SDD cohort and for comparison between SDD and ONS cohorts. Pooled estimates for complications after SDD were low both for short-term [2%; 95% confidence interval (CI) 1-5%; I2 89%) and 30-day follow-up (2%; 95% CI 1-4%; I2 91%). There was no significant difference in complications rates between SDD and ONS [short-term risk ratio (RR) 1.62; 95% CI 0.52-5.01; I2 37%; 30 days RR 0.65; 95% CI 0.42-1.00; I2 95%). Pooled rates of re-hospitalization/ER visits after SDD were 4% (95% CI 1-10%; I2 96%) with no statistically significant difference between SDD and ONS (RR 0.86; 95% CI 0.58-1.27; I2 61%). Pooled 30-day mortality was low after SDD (0%; 95% CI 0-1%; I2 33%). All studies were subject to a relevant risk of bias, mainly due to study design.CONCLUSION:
In this meta-analysis including a large contemporary cohort, SDD after AF ablation was associated with low prevalence of post-discharge complications, re-hospitalizations/ER visits and mortality, and a similar risk compared with ONS. Due to limited quality of current evidence, further prospective, randomized trials are needed to confirm safety of SDD and define patient- and procedure-related prerequisites for successful and safe SDD strategies.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Alta do Paciente
/
Readmissão do Paciente
/
Fibrilação Atrial
/
Ablação por Cateter
/
Tempo de Internação
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article