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

Area of Science:

• Cardiology
• Cardiac Surgery
• Clinical Quality Improvement

Background:

• Atrial fibrillation after cardiac surgery (AFACS) is a common complication.
• Current guidelines recommend early beta-blocker administration for AFACS prevention.
• Implementing these guidelines can face significant barriers in clinical practice.

Purpose of the Study:

• To adapt and implement a practice advisory for AFACS prevention into local perioperative protocols.
• To focus on the early postoperative (re)introduction of beta-blockers.
• To overcome barriers in guideline implementation for AFACS prevention.

Main Methods:

• A model for improvement approach using a prevention care bundle and repeated audits.
• Development and implementation of a 5-pillar care bundle based on current evidence.
• Retrospective analysis of 384 patients undergoing open cardiac surgery before and after bundle implementation.

Main Results:

• Increased postoperative beta-blocker administration (82.7% to 91.3%, p=0.019), with earlier initiation (36.7% to 67% on day 1, p<0.001).
• Significant reduction in AFACS incidence from 35.4% to 23.3% (p=0.009).
• Noteworthy AFACS reduction observed in patients aged 65-75 and those undergoing isolated aortic valve or coronary artery bypass graft surgery.

Conclusions:

• The AFACS prevention care bundle improved adherence to guidelines for early beta-blocker administration.
• Implementation of the care bundle significantly reduced the incidence of atrial fibrillation after cardiac surgery.
• This strategy demonstrates a successful approach to improving clinical practice and patient outcomes.