Digital virtual ward versus standard of care for acute atrial fibrillation: A single centre non-randomised pilot comparison of clinical outcomes and cost
Ahmed Kotb, Suzanne Armstrong, Ibrahim Antoun, Sarah Anthony, Rachel Hobson, Joseph Barker, Ivelin Koev, Paul Smith, Shui Hao Chin, Guiqing Lily Yao, G André NgAbstract
Background
Atrial fibrillation (AF) incurs significant healthcare costs, mainly from acute hospitalisations. Digitally-enabled models could provide hospital-level care at home for selected patients, but evidence in acute care remains inconsistent.
Methods
In a propensity score-matched, non-randomised comparative study using real-world data (January–December 2022). Adults with acute AF admitted to the AF virtual ward (AFVW) were matched 1:1 to standard-of-care (SOC) inpatients meeting AFVW eligibility criteria. The primary outcome was a composite of emergency readmissions, urgent care attendance, or death within 90 days. A separate cost analysis was undertaken from the National Health Service (NHS) secondary care perspective.
Results
Ninety-one AFVW patients were matched to 91 SOC patients. The primary outcome did not differ at 90 days (HR 0.61, 95% CI 0.34-1.10). Emergency bed-day use following readmission was higher in AFVW cohort (0.42 vs 0.07 per spell; ratio 6.04; 95% CI 2.70-15.90), although the readmission rate itself was similar (7.7% versus 7.0%). Thirty-day emergency attendances, outpatient appointments, and mortality were similar. In a separate, clinically screened but non-propensity-matched population (75 AFVW, 315 SOC patients), mean direct secondary-care cost per patient was £948 versus £1,631, an adjusted saving of £642. Friends and Family Test respondents rated the AFVW positively.
Conclusion
We found no significant difference in adverse outcomes between an acute AF virtual ward and matched SOC, but the study was not powered for non-inferiority, and downstream emergency bed-day use was higher in the virtual ward arm. AFVW costs were lower in an exploratory analysis. These findings require confirmation in future studies.