ABSTRACT
Aim To examine safety and efficiency of electrocardioversion (EC) in elective treatment of atrial fibrillation and atrial flutter in the setting of Day Hospital by determining success rate, frequency of adverse events and possible cost benefit compared to admitting a patient into hospital. Methods This prospective observational cohort study was performed in Day Hospital and in Intensive Care Department of Internal Medicine Clinic, University Clinical Centre Tuzla from January 2019 to December 2022 and included 98 patients with a persistent form of atrial fibrillation (AF) or atrial flutter. The patients who were divided in two groups, 56 hospitalized and 42 patients accessed in Day Hospital. In all patients, medical history, physical examination, electrocardiogram (ECG) and transthoracic echocardiogram (TTE) evaluation was performed in addition to laboratory findings. Electrocardioversion was performed with a monophasic General Electric defibrillator in anterolateral electrode position with up to three repetitive shocks. Results In hospital setting group overall succes rate of electrocardioversion was 85%, with average 2.1 EC attemps, there was with one fatal outcome due to stroke, one case of ventricular fibrillation (VF) due to human error, and 6 minor adverse events; with average cost of was 1408.70 KM (720.23 ) per patient. In Day Hospital setting succes rate was 88%, with average 2 EC attempts, no major adverse events, 8 minor adverse events; and average cost was of 127.23 KM (65.05 ) per patient. Conclusion Performing elective electrocardioversion in Day Hospital setting is as safe as admitting patients into hospital but substantially more cost effective.
ABSTRACT
INTRODUCTION: Accurate information about the cause of death is given by expert teams based on pathological or forensic expertise. Reliable information can be obtained from doctors from clinical-hospital institutions if the deceased person was treated in such an institution and with previously diagnosed disease (hospital mortality). Analysis of hospital mortality provides a lot of data that can be used in planning the hospital beds capacities, the amount of drug procurement, purchasing equipment, organization and creation of highly specialized medical teams (medical team for resuscitation), the number of reanimation techniques, the number of pathologists who are required for autopsy procedures, etc. GOAL was to determine the total number of deaths, the most common causes of death and the 10 leading diagnoses of deceased patients at the Clinic for Internal Medicine of Clinical Center in Tuzla during 2008. MATERIAL AND METHODS: We used the material from the archive (medical records and reports on deceased patients, delivered by physicians working at the Clinic for Internal Medicine of Clinical Center in Tuzla). RESULTS: During 2008 at the Clinic for Internal Medicine 368 patients died. According to the analyzed data leading cause of death and leading diagnosis as cause of death at the Clinic for Internal Medicine in 2008 were as follows: cardiogenic shock in 73 (19.84%), cerebrovascular stroke in 46 (12.50%), coma due to stroke in 32 (8.70%), coma not classified as cerebral in 25 (6.79%) (metabolic 13 (3.53%) and hepatic 12 (3.26%), cardiomyopathy in 22 (5.98%), malignant neoplasm of the abdomen in 17 (4.62%), respiratory insufficiency in 17 (4.62%), acute myocardial infarction and myocardial infarction with rupture in 17 (4.62%), pulmonary edema in 16 (4.35%), and cardiorespiratory arrest in 13 (3.53%) deaths. CONCLUSION: During 2008 at the Clinic for Internal Medicine of Clinical Center in Tuzla died a total of 368 patients. The most common cause of death of patients at the Clinic for Internal Medicine of Clinical Center in Tuzla are cardiovascular disease (n = 175; 47.55% of deaths), in second place was cerebrovascular disease (n = 76; 20.65% of deaths) for a total of 251 (68.20%) of deaths from cardiovascular and cerebrovascular disease.
