BACKGROUND: The economic burden of atrial fibrillation (AF) continues to increase. AF treatment pathways have been shown to reduce avoidable admissions, but the effects on health care costs are not understood. This study sought to assess the impact of an AF treatment pathway on health service charges and emergency department (ED) discharge rates. METHODS: An AF treatment pathway was implemented at 7 hospital EDs in North Carolina between 2017 and 2020. Thirty-day health service charges were calculated for ED visits, hospitalizations, and outpatient clinic appointments. A quasi-experimental design was used to assess changes in health service charges and ED discharge rates following implementation of the AF treatment pathway. Adjusted quantile and negative binomial regressions were used to analyze changes in median 30-day health service charges and discharge rates from the ED, respectively. RESULTS: Among 12 504 patients that met eligibility for study inclusion (preperiod: n=3893
postperiod: n=8611), implementation of the AF treatment pathway significantly reduced 30-day health service charges (preperiod: 1 922
postperiod: 219
CONCLUSIONS: The implementation of an AF treatment pathway in the ED was associated with a decrease in median 30-day health service charges and an increase in ED discharge rate for patients presenting with AF.