Doing Simple Things Well: Practice Advisory Implementation Reduces Atrial Fibrillation After Cardiac Surgery.
J Cardiothorac Vasc Anesth
; 34(11): 2913-2920, 2020 Nov.
Article
en En
| MEDLINE
| ID: mdl-32741608
ABSTRACT
OBJECTIVES:
The 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 ß-blockers and overcoming frequent guideline implementation barriers.DESIGN:
Development of a prevention care bundle and repeated audit after a model of improvement approach with retrospective analysis.SETTING:
Single center (tertiary academic hospital).PARTICIPANTS:
A total of 384 patients in 2 cohorts of consecutive patients undergoing open cardiac surgery before and after hospital-wide implementation of a care bundle.INTERVENTIONS:
After 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 MAINRESULTS:
Significantly more patients received postoperative ß-blockers after care bundle implementation (82.7% pre- v 91.3% post-bundle, pâ¯=â¯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% (pâ¯=â¯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.CONCLUSION:
An AFACS prevention care bundle improved adherence to current guidelines with regard to early ß-blocker administration and significantly reduced the incidence of atrial fibrillation after cardiac surgery.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Fibrilación Atrial
/
Procedimientos Quirúrgicos Cardíacos
Tipo de estudio:
Etiology_studies
/
Guideline
/
Observational_studies
Límite:
Aged
/
Humans
Idioma:
En
Revista:
J Cardiothorac Vasc Anesth
Asunto de la revista:
ANESTESIOLOGIA
/
CARDIOLOGIA
Año:
2020
Tipo del documento:
Article