It's OK, doc, I got this one

Patients pop an anti-arrhythmic — and save their own lives

A pill in the pocket puts a stop to emergency hospital visits

By Eileen Dent

As a society, we're often criticized for our pill popping mentality and our obsession with finding quick fixes. But if a problem can be fixed, well what's wrong with making it quick? That's certainly the attitude taken by the authors of a study in the December 2 issue of the New England Journal of Medicine. They claim that a dose of either flecainide or propafenone may be just as effective as hospital treatment for most atrial fibrillation patients.

Dr Paolo Alboni and his colleagues from the Ospedale Civile in Cento, Italy enrolled 210 patients in the study after determining that they responded well to either one of two anti-arrhythmics, flecainide or propafenone, in a hospital setting. The patients were told to have their flecainide or propafenone pills handy at all times, and to throw them down the hatch if heart palpitations set in. Over the approximately 15 months of the study, 165 patients experienced 618 arrhythmic episodes. However, patient compliance — the bane of most physicians' lives — isn't always as stellar as we hope for. Consequently, not all subjects had their pills ready when they needed them and only 569 of those 618 episodes were treated with medication.

Ninety-four percent, or 534 of the 569 episodes treated by the pills, were safely interrupted within six hours. Only 26 episodes warranted a visit to the emergency room. Of these 26, seven participants had actually successfully halted the arrhythmia on their own, but sought medical help just in case.

KICK THE ER DEPENDENCY
"Data from our study show that the pill-in-the-pocket strategy is effective in more than 80% of patients with recurrent atrial fibrillation," say the study authors. Not surprisingly, the 'pill in the pocket' approach also reduced hospitalizations and emergency room visits. For all 210 patients enrolled in the study, hospital visits dropped from 45.6 times per month to just 4.9 visits per month after the participants learned to administer their own medicine at home.

As the authors point out, "out-of-hospital treatment minimizes subsequent emergency room visits and hospitalization, which should reduce the costs associated with atrial fibrillation."

That's excellent news given that 5% of adults in Canada over the age of 69 are affected by atrial fibrillation. With our aging population, we should expect to see more and more patients develop this problem. So a pill in the pocket that reduces hospital visits by 90% would help put more money back into our struggling healthcare system.