Same-day discharge after cardiac ablation: Cardiologists share recommendations
The Heart Rhythm Society (HRS) and American College of Cardiology have collaborated on a new scientific statement focused on the practice of same-day discharge (SDD) after intracardiac catheter ablation procedures.
The new document, published in both Heart Rhythm and JACC: Clinical Electrophysiology, reviews both clinical trial data and real-world evidence to evaluate the safety, effectiveness and costs of implementing an SDD strategy.[1, 2] It also emphasizes the importance of using a shared decision-making approach that considers the specific details of each patient’s case instead of making broad generalizations.
The scientific statement also focused on the potential cost savings associated with implementing an SDD approach when appropriate. Both health systems and the patients themselves can save substantial amounts of money by getting out of the hospital and into the comfort of home on the same day they undergo treatment.
“This consensus document evaluates global trends and evidence supporting shorter hospitalization stay with SDD for intracardiac ablations agnostic to site of care,” veteran electrophysiologist Amit Shanker, MD, vice-chair of the HRS Health Policy and Regulatory Affairs Committee and co-chair of the document, said in a statement. “With rising demand straining healthcare access, SDD addresses systemic challenges by driving patient availability and improving operational efficiencies and care quality. By reducing overnight stays and resource utilization, SDD protocols can lower healthcare costs while maintaining safety, aligning clinical priorities with fiscal sustainability.”
“The field of EP continues to evolve due to improved workflows, technological innovations, and procedural advancements,” added Samuel O. Jones, MD, co-chair of the document. “Fueled by the COVID pandemic, many centers adopted same-day discharge protocols, which have continued to be refined. A growing body of literature supports this paradigm for patients appropriately selected by the electrophysiologist, as safe and effective, as well as patient-centered, while also freeing up necessary resources in the healthcare facility.”
Which patients are eligible for same-day discharge?
One key takeaway from the document is the number of patient factors a care team needs to consider when determining if SDD is a safe treatment strategy. When patients undergo atrial fibrillation ablation, for instance, clinicians should confirm the absence of decompensated heart failure, significant pulmonary disease, unstable medical comorbidities and significant bleeding diathesis.
The patient’s proximity to a hospital is another detail to consider—how far will they be when they are recovering? Would it take hours of driving if a complication did occur and they had to return for further treatment?
On a related note, the authors noted that SDD only makes practical sense if the patient has support from a family member or friend. In the REAL-AF registry study, they explained, “social issues” were the primary reason that 70% of patients who were originally being considered for SDD ultimately ended up staying in the hospital overnight.
“These issues included patient preference, inadequate social support, and the distance from the patient’s home to the hospital,” the group wrote. “These data suggest that social and clinical factors are equally significant considerations in determining the appropriateness of SDD following cardiac catheter ablations.”
There are also a wide variety of procedural considerations to keep in mind. This includes the length of the procedure as well as its complexity, the type of anesthesia employed, the time to recovery from anesthesia and much more.
“Depending on the availability of nurses and ancillary support staff to monitor and discharge patients, procedure termination after specific times in the later hours of a calendar day may render patients ineligible for SDD,” the authors wrote. “The prolonged duration of catheter ablation procedures impacts patient recovery time (due to extended administration of anesthetic agents) and time to potential discharge from the facility. Conversely, administering short-acting anesthetic agents such as propofol and minimizing intravenous fluids can facilitate rapid recovery after cardiac catheter ablation.”
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.