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Background: Same day discharge (SDD) following atrial fibrillation (AF) ablation procedure has emerged as routine practice, and primarily driven by operator discretion. However, the impacts of SDD on clinical outcomes, healthcare system costs, and patient reported outcomes (PROs) have not been systematically studied. Methods: We retrospectively analyzed patients undergoing routine AF ablation procedures with SDD versus overnight observation (NSDD). After propensity adjustment we compared postprocedure adverse events (AEs), healthcare system costs, and changes in PROs. Results: We identified 310 cases, with 159 undergoing SDD and 151 staying at least one midnight in the hospital (NSDD). Compared with NSDD, SDD patients were similar age (mean 64 vs. 66, p = 0.3), sex (26% female vs. 27%, p = 0.8), and with lower mean CHADS2‐VA2Sc scores (2.0 vs. 2.7; p < 0.011). The primary outcome of AEs was noninferior in SDD versus NSDD patients (odds ratio 0.45, 95% confidence interval 0.21−0.99; noninferiority margin of 10%). There were also no differences in overall cost to the healthcare system between SDD and NSDD (p = 0.11). PROs numerically favored SDD (p = NS for all scores). Conclusions: Physician selection for SDD appears at least as safe as NSDD with respect to clinical outcomes and SDD is not significantly less costly to the health system. There is a trend towards more favorable, general PROs among SDD patients. Routine SDD should be strongly considered for patients undergoing routine AF ablation procedures. [ABSTRACT FROM AUTHOR]

Background: We aimed to measure patient‐reported outcomes (PROs) and costs associated with same‐day discharge (SDD) for atrial fibrillation (AF) ablation and vascular closure device implantation in clinical practice. Methods: PROs were prospectively measured in 50 AF ablation patients, comparing complete vascular device closure (n = 25) versus manual 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 any closure device. Results: Prospectively enrolled patients receiving vascular device closure for AF ablation had a mean age of 65 years, 17% were female, with a mean CHA2DS2‐VASc score of 3. The mean number of venous sheaths was higher among patients receiving vascular device closure (3.8 vs. 3.1, p < 0.001), and there was one case of rebleeding in a patient receiving a vascular closure device (no other 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 better among patients receiving vascular closure. In matched analyses of health‐system costs, patients with vascular closure had mean age 66, 32% were female, and the mean CHA2DS2‐VASc score was 2 (p = NS vs. controls). SDD with vascular closure was associated with the significantly lower facility, pharmacy, and disposable costs, but higher implant costs. Overall costs for ablation were not significantly different (mean difference 1.10%, 95% confidence interval [CI] −3.03 to 5.42). Conclusions: Vascular closure for AF ablation improves patient experience in routine care. The use of vascular closure and SDD after AF ablation reduces several components of healthcare system costs, without an overall increase. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) significantly reduces health‐related quality of life (HRQoL), previously measured in clinical trials using patient‐reported outcomes (PROs). We examined AF PROs in clinical practice and their association with subsequent clinical management. Methods: The Utah My Evaluation (mEVAL) program collects the Toronto AF Symptom Severity Scale (AFSS) in AF outpatients at the University of Utah. Baseline factors associated with worse AF symptom score (range 0–35, higher is worse) were identified in univariate and multivariable analyses. Secondary outcomes included AF burden and AF healthcare utilization. We also compared subsequent clinical management at 6 months between patients with better versus worse AF HRQoL. Results: Overall, 1338 patients completed the AFSS symptom score, which varied by sex (mean 7.26 for males vs. 10.27 for females; p <.001), age (<65, 9.73; 65–74, 7.66; ≥75, 7.58; p <.001), heart failure (9.39 with HF vs. 7.67 without; p <.001), and prior ablation (7.28 with prior ablation vs. 8.84; p <.001). In multivariable analysis, younger age (mean difference 2.92 for <65 vs. ≥75; p <.001), female sex (mean difference 2.57; p <.001), pulmonary disease (mean difference 1.88; p <.001), and depression (mean difference 2.46; p <.001) were associated with higher scores. At 6‐months, worse baseline symptom score was associated with the use of rhythm control (37.1% vs. 24.5%; p <.001). Similar cofactors and results were associated with increased AF burden and health care utilization scores. Conclusions: AF PROs in clinical practice identify highly‐symptomatic patients, corroborating findings in more controlled, clinical trials. Increased AFSS score correlates with more aggressive clinical management, supporting the utility of disease‐specific PROs guiding clinical practice. [ABSTRACT FROM AUTHOR]