• J. Cardiothorac. Vasc. Anesth. · Nov 2020

    Doing Simple Things Well: Practice Advisory Implementation Reduces Atrial Fibrillation After Cardiac Surgery.

    • Martina Buerge, Rosalie Magboo, Dylan Wills, Ioannis Karpouzis, Damian Balmforth, Paul Cooper, Neil Roberts, and Ben O'Brien.
    • Department of Perioperative Medicine, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom. Electronic address: martina.buerge@nhs.net.
    • J. Cardiothorac. Vasc. Anesth. 2020 Nov 1; 34 (11): 2913-2920.

    ObjectivesThe authors aimed to adapt a practice advisory for the prevention of atrial fibrillation after cardiac surgery (AFACS) recently published in this journal into the authors' local perioperative protocols, implementing the recommendations, with a focus on early postoperative (re)introduction of β-blockers and overcoming frequent guideline implementation barriers.DesignDevelopment of a prevention care bundle and repeated audit after a model of improvement approach with retrospective analysis.SettingSingle center (tertiary academic hospital).ParticipantsA total of 384 patients in 2 cohorts of consecutive patients undergoing open cardiac surgery before and after hospital-wide implementation of a care bundle.InterventionsAfter auditing the standard of care in the authors' center, an AFACS prevention care bundle was designed and implemented, consisting of a graphic tool with 5 pillars based on current evidence for the early postoperative phase. Multidisciplinary teaching and training of staff were delivered, and a second audit was conducted after the implementation period.Measurements And Main ResultsSignificantly more patients received postoperative β-blockers after care bundle implementation (82.7% pre- v 91.3% post-bundle, p = 0.019), with a higher proportion on day 1 (36.7% pre- v 67% post-bundle, p < 0.001), indicating a successful uptake. The incidence of AFACS was significantly reduced from 35.4% to 23.3% (p = 0.009), with a particularly marked reduction in the age group 65- to 75- years and for isolated aortic valve and coronary artery bypass graft surgery.ConclusionAn AFACS prevention care bundle improved adherence to current guidelines with regard to early β-blocker administration and significantly reduced the incidence of atrial fibrillation after cardiac surgery.Copyright © 2020 Elsevier Inc. All rights reserved.

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