Background Electrical cardioversion (ECV) and catheter ablations are elective non-pharmacological approaches that aim to restore sinus rhythm (SR) in atrial fibrillation (AF) patients. Patients require anticoagulation peri-procedurally to prevent thrombo-embolic events.
Purpose To evaluate the reasons behind procedure cancellations in patients with AF and investigate the impact on patient outcome post-procedure, including its association with procedure waiting time and cost.
Material and methods A retrospective service evaluation was conducted at a UK teaching hospital. Appointments for ECV and ablation procedures from August 2012 to August 2013 were studied; 72 patients (cancellation group) experienced cancellations and 89 patients (control group) experienced none. ‘Electronic Patient Records’ and ‘TOMCAT’ software were used to obtain data. For the Mann-Whitney U and chi-squared tests, p < 0.05 was considered significant.
Results Of the 98 reasons identified for cancellations, high and low international normalised ratio (INR) ranges were the most common at n = 14 (14%) and n = 12 (12%), respectively. Patients who experienced a longer waiting time were more likely to experience subsequent cancellations (p = 0.006); more patients from the cancellation group breached the 18-week target waiting limit (p < 0.001). Procedure cancellations showed no significant impact on reaching sinus rhythm or experiencing recurrences of arrhythmia (p = 0.946) however a total loss in revenue resulted of around €215,000.
Conclusion Prescribing direct-acting oral anticoagulants (DOAC) may prevent INR-related cancellations and this is an expanding area of use. Post-marking surveillance is still ongoing but the risk of poor patient adherence to treatment and post-procedure bleeding needs to be balanced with the potentials gains to the hospital department.
References and/or Acknowledgements 1 Camm AJ, et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology. Eur Heart J 2010;19(31):2369–429
No conflict of interest.
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