Cardiothoracic & vascular anesthesia
Prevention of postoperative atrial fibrillation in cardiac surgery: a quality improvement project
Authors' conclusion
This single-centre QI intervention increased the use of prophylactic amiodarone by 28% for patients at elevated risk of POAF, with no change in the early postoperative initiation of beta blockers (46.7% of patients by POD1). There was a notable reduction in the incidence of POAF in patients at elevated risk undergoing surgery.
Study context
- Population
- Patients undergoing cardiac surgery
- Participants
- 560 patients
- Exposure
- Quality improvement (QI) initiative vs baseline
- Outcome
- Incidence of POAF and use of prophylactic medications
- Follow-up
- 11 months
Methodological detailssingle-centre, Plan, Do, Study, Act (PDSA) cycle, longitudinal audit
- Single-centre
- Plan, Do, Study, Act (PDSA) cycle
- Longitudinal audit
Main finding
As reported in the abstract
Baseline rate of postoperative atrial fibrillation (POAF), all surgical subtypes
39%
198/560
Overall incidence of POAF after 11 months
29%
Relative reduction in POAF
24.9%
Observational data: associations, not effects.
Further findings
Prophylactic amiodarone use in high-risk patients
- Start of project
- 13% (1/8)
- End of audit period
- 41% (48/116)
Beta blocker on POD1
- December 2020
- 34.8%
- October 2021
- 46.7%
- Fluctuated but essentially unchanged throughout the audit
POAF incidence in complex surgical subtypes (subgroup), start vs end of audit
- Multiple valve replacement
- 89% vs 56%
- Aortic repair
- 50% vs 33%
- Mitral valve surgery
- 45% vs 33%
Original publication
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