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Current Research: Cardiology

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Real-life practice in the management of new-onset postoperative atrial fibrillation early after cardiac surgery

Author(s): Michelle Berresheim, Arden R Barry, Colleen M Norris RN, Sheri L Koshman, Jayan Nagendran and Glen J Pearson*

Objectives: To investigate the real-world pharmacological management of postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery.

Methods: A retrospective cohort analysis consisting of adult patients who underwent coronary artery bypass grafting, valve or combined surgery from January to December 2011 was performed using a clinical registry. The peri- and postoperative pharmacological management (rate control, rhythm control, anticoagulant therapy) of POAF was evaluated. Stepwise multivariate regression analyses were used to identify determinants for medication use at discharge.

Results: The cohort consisted of 1145 patients, of whom 377 (32.9%) developed POAF and 271 (23.7%) were included. At discharge, 251 patients (92.6%) received β-blocker therapy and 122 (45.0%) received antiarrhythmic therapy. Two hundred sixty-one (96.3%) received rateand/ or rhythm-control therapy. Forty-eight (17.7%) patients received warfarin on discharge, although 38 had an additional indication. Men and urgent inpatients were less likely to be discharged on warfarin. Among 145 patients discharged on antiarrhythmic and/or anticoagulant therapy, 121 (83.4%) attended follow-up. Only 28.1% (34 of 121) had an electrocardiogram or Holter monitoring performed; despite this, antiarrhythmic medications were either continued or not addressed in 47.7% (51 of 107) of patients discharged on therapy.

Conclusions: Treatment of POAF with rate- and/or rhythm-control medications was consistent with current national guideline recommendations. However, anticoagulant therapy use was low and appeared to be limited to patients with another indication. Assessment of POAF medications and rhythm status at postoperative follow-up visit was inconsistent. Thus, efforts to improve the management of POAF should focus on appropriately discontinuing unnecessary medications at postoperative follow-up to minimize the risk of adverse effects.

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Current Research: Cardiology