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

Abstract

Aims Same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) may may address the growing socio-economic health burden of the increasing demand for interventional AF-therapies. This systematic review and meta-analysis analyzes the current evidence on clinical outcomes in SDD after AF-ablation compared to overnight stay (ONS). Methods and Results A systematic search of the PubMed-database was performed. Predefined endpoints were complications at short-term (24-96h) and 30 days post-discharge, re-hospitalization and/or emergency room (ER)-visits at 30 days 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%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: 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 to 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.