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Espinosa T, Farrus A, Venturas M, Cano A, Vazquez-Calvo S, Pujol-Lopez M, Eulogio-Valenzuela F, Guichard JB, Falzone PV, Graterol FR, Freixa X, Tolosana JM, Guasch E, Porta-Sanchez A, Arbelo E, Brugada J, Sitges M, Mont L, Roca-Luque I, Althoff TF. Same-day discharge after atrial fibrillation ablation under a nurse-coordinated standardized protocol. Europace 2024; 26:euae083. [PMID: 38571291 PMCID: PMC11020282 DOI: 10.1093/europace/euae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024] Open
Abstract
AIMS Same-day discharge (SDD) after atrial fibrillation (AF) ablation is an effective means to spare healthcare resources. However, safety remains a concern, and besides structural adaptations, SDD requires more efficient logistics and coordination. Therefore, in this study, we implement a streamlined, nurse-coordinated SDD programme following a standardized protocol. METHODS AND RESULTS As a dedicated SDD coordinator, a nurse specialized in ambulatory cardiac interventions was in charge of the full SDD protocol, including eligibility, patient flow, in-hospital logistics, patient education, and discharge as well as early post-discharge follow-up by smartphone-based virtual visits. Patients planned for AF ablation were considered eligible if they had a left ventricular ejection fraction (LVEF) ≥35%, with basic support at home and accessibility of the hospital within 60 min also forming a part of the eligibility criteria. A total of 420 consecutive patients were screened by the SDD coordinator, of whom 331 were eligible for SDD. The reasons for exclusion were living remotely (29, 6.9%), lack of support at home (19, 4.5%), or LVEF <35% (17, 4.0%). Of the eligible patients, 300 (91%) were successfully discharged the same day. There were no major post-SDD complications. Rates of unplanned medical attention (19, 6.3%) and 30-day readmission (5, 1.6%) were extremely low and driven by femoral access-site complications. These were significantly reduced upon the introduction of compulsory ultrasound-guided punctures after the initial 150 SDD patients (P = 0.0145). Standardized SDD coordination resulted in efficient workflows and reduced the total workload of the medical staff. CONCLUSION Same-day discharge after AF ablation following a nurse-coordinated standardized protocol is safe and efficient. The concept of ambulatory cardiac intervention nurses functioning as dedicated coordinators may be key in the future transition of hospitals to SDD. Ultrasound-guided femoral puncture virtually eliminated relevant femoral access-site complications in our cohort and should therefore be a prerequisite for SDD.
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Affiliation(s)
- Teresa Espinosa
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | - Anna Farrus
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | - Montserrat Venturas
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | - Alba Cano
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | - Sara Vazquez-Calvo
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Margarida Pujol-Lopez
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Frida Eulogio-Valenzuela
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Jean-Baptiste Guichard
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Pasquale V Falzone
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Freddy R Graterol
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Xavier Freixa
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Jose M Tolosana
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Eduard Guasch
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Andreu Porta-Sanchez
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Josep Brugada
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Marta Sitges
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Lluis Mont
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Ivo Roca-Luque
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Till F Althoff
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
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