{
  "abstract": "Introduction Atrial Fibrillation (AF) is associated with significant costs to healthcare, mainly driven by acute hospitalisations. Digitally enabled acute care models have been developed to facilitate remote care for selected patients. However, evidence on costs and value remains inconsistent. This study evaluates the safety and NHS provider-side direct costs of an acute AF virtual ward (AFVW).Methods A propensity score matched, non-randomised comparative cohort study was conducted at a UK tertiary centre between January and December 2022. AFVW patients were matched 1:1 to standard-of-care (SOC). The primary outcome was a composite of emergency readmission, attendance at the emergency department or general practitioner assessment unit, or death within 90 days of index discharge. A cost-analysis was undertaken from the NHS provider perspective using patient-level and spell-level costing data. Total cost and cost per day were analysed using Gamma generalized linear models with log link, Costs were reported in 2022 GBP.Results Ninety-one AFVW patients were matched to 91 SOC patients. Baseline characteristics were similar and only eight of 49 variables showed residual imbalance. There was no significant difference in the composite outcome (hazard ratio 1.63, 95% CI 0.91 to 2.90). Thirty-day readmissions, emergency attendances, outpatient appointments, and mortality were similar across groups ( table 1). Emergency bed-day use following readmission was higher in the AFVW cohort (0.42 bed days per patient versus 0.07 bed days per patient in the matched control group, ratio 6.04; 95% CI 2.70 to 15.90). Cost analysis included 329 SOC admissions and 75 VW patients (8 had more than one care episode). Mean total cost was higher in SOC than VW (£1,561.57 vs £947.85). Bootstrap estimates were consistent, and the unadjusted mean cost difference favoured VW by £614 (95% CI £393 to £841).Conclusion An acute AF virtual ward model delivered comparable safety outcomes to SOC while reducing direct provider costs. Longer, multicentre, prospective studies are needed to facilitate wider implementation.Abstract 531 Table 1Comparison of subsequent hospital activity and patient outcomes between groups following index dischargeAFVW GroupSOC GroupMeasureActivityDenominatorRateActivityDenominatorRateA&E attendances within 30 days of discharge61045.8%51005.0%GPAU attendances within 30 days of discharge01040.0%21002.0%Emergency readmissions within 30 days of discharge81047.7%71007.0%Emergency readmissions within 30 days of discharge – circulatory conditions only81047.7%61006.0%Emergency bed days following emergency admission within 30 days441040.42**71000.07**Mortality within 30 days of discharge1911.1%0910.0%Mortality within 90 days of discharge1911.1%1911.1%All recorded mortality following discharge3913.3%5915.5%Outpatient first attendances within 3 months36910.4042910.46Outpatient first attendances within 3 months – cardiology only26910.2926910.29*Statistically significant, P-value < 0.05; **Statistically significant, P-value < 0.001. AFVW, Atrial fibrillation virtual ward; SOC, Standard-of-care",
  "authors": [
    {
      "affiliations": [
        "Leicester British Heart Foundation Centre of Research Excellence",
        "Department of Cardiovascular Sciences, Leicester National Institute for Health and Care Research Biomedical Research Centre, University of Leicester",
        "East Sussex Healthcare NHS Trust, UK"
      ],
      "name": "Ahmed Kotb"
    },
    {
      "affiliations": [
        "Leicester British Heart Foundation Centre of Research Excellence",
        "Department of Cardiovascular Sciences, Leicester National Institute for Health and Care Research Biomedical Research Centre, University of Leicester"
      ],
      "name": "Suzanne Armstrong"
    },
    {
      "affiliations": [
        "Leicester British Heart Foundation Centre of Research Excellence",
        "Department of Cardiovascular Sciences, Leicester National Institute for Health and Care Research Biomedical Research Centre, University of Leicester"
      ],
      "name": "Ibrahim Antoun"
    },
    {
      "affiliations": [
        "Leicester British Heart Foundation Centre of Research Excellence",
        "Department of Cardiovascular Sciences, Leicester National Institute for Health and Care Research Biomedical Research Centre, University of Leicester"
      ],
      "name": "Sarah Anthony"
    },
    {
      "affiliations": [
        "Leicester British Heart Foundation Centre of Research Excellence",
        "Department of Cardiovascular Sciences, Leicester National Institute for Health and Care Research Biomedical Research Centre, University of Leicester"
      ],
      "name": "Rachel Hobson"
    },
    {
      "affiliations": [
        "Leicester British Heart Foundation Centre of Research Excellence",
        "Department of Cardiovascular Sciences, Leicester National Institute for Health and Care Research Biomedical Research Centre, University of Leicester"
      ],
      "name": "G Andre Ng"
    }
  ],
  "title": "531 Digitally enabled acute care for atrial fibrillation: a propensity score-matched safety and cost analysis",
  "uid": "3434c198-6dd2-5e4d-8cd8-4a6ac66534ef"
}