RESUMO
OBJECTIVE: To examine the incidence of atrial fibrillation (AF) newly developed after cardiovascular surgery in Vietnam, its associated risk factors, and postoperative complications. We also sought to evaluate the feasibility of a novel screening strategy for post-operative AF (POAF) using the combination of two portable devices. METHODS: Single-centre, prospective cohort study at the Cardiovascular Centre, E Hospital, Hanoi, Vietnam. All patients aged≥18 years, undergoing cardiovascular surgery and in sinus rhythm preoperatively were eligible. The primary outcome was occurrence of new-onset POAF detected by hand-held single-lead electrocardiography (ECG) or a sphygmomanometer with AF-detection algorithm. Multivariate logistic regression was used to identify risk factors of developing post-operative AF. Feasibility was evaluated by compliance to the protocol and semi-structured interviews. RESULTS: 112 patients were enrolled between 2018-2019: mean age 52.9±12.2 years; 50.9% female;92.0% (n=103) valve surgery; 9.8% (n=11)coronary surgery. New-onset POAF developed in 49patients (43.8%) with median time to onset 1.27days (IQR 0.96 -2.00 days). Age≥65 years was the only significant risk factor for the development of POAF(OR 3.78, 95% CI 1.16-12.34).The median thromboembolism risk scores (CHA2DS2-VASc score) were comparable among patients with and without POAF (1.0 vs. 1.0, p=0.104). The occurrence of POAF was associated with higher rates of postoperative complications (24.5% vs. 3.2%, p<0.001). Both doctors and nurses found this screening strategy feasible to be implemented long-term with the main difficulties being the instructions on both devices were in English, and an increase in workload. CONCLUSIONS: In this single-centre study, new-onset POAF occurred in 43.8% of patients who underwent cardiovascular surgery. This novel POAF screening strategy was feasible in a low resource setting, and its implementation could be improved by providing continuous training and translation to local language.
RESUMO
OBJECTIVES: This study aimed to evaluate the imprecision and bias data generated for 20 routine chemistry analytes against both the biological variation fitness for purpose (FFP) and Sigma metrics (SM) criteria. DESIGN AND METHOD: Twenty serum/plasma analytes were evaluated on the Beckman Coulter AU680. Third party commercial lyophilized internal quality control samples of human origin were used for day-to-day imprecision calculations. Commercial external quality assurance (EQA) samples were used to determine the systematic error between the test method result and the instrument group mean result from the EQA program for each analyte. Biological variation data was used to calculate the minimum, desirable and optimal imprecision and bias for determination of FFP. The desirable total allowable error was determined from biological variation data and applied to the SM calculation. The outcomes of both quality approaches were then compared. RESULTS: The day-to-day imprecision of most tested analytes (except sodium and chloride) were smaller than the allowable imprecision (ranging from minimum to optimum). Most analytes achieved at least minimum bias. The SM varied with analyte concentration with six analytes producing low Sigma values. Comparing the quality processes eleven analytes produced a green light for both FFP and SM. There was some difference seen in interpretation for the other nine analytes. CONCLUSIONS: The individual interpretation of bias and imprecision using FFP criteria allowed for the clear determination of the major source of error. Whereas, SM provided a summative evaluation of method performance. But the selection of total allowable error (TEa) is fundamental to this interpretation and harmonisation of the TEa calculation is needed.
