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

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 β-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 main results: Significantly more patients received postoperative β-blockers after care bundle implementation (82.7% pre- v 91.3% post-bundle, p = 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% (p = 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 β-blocker administration and significantly reduced the incidence of atrial fibrillation after cardiac surgery.

Keywords: Plan-Do-Study-Act; Postoperative atrial fibrillation; cardiac surgery; implementation barriers; model for improvement approach; postoperative β-blockers; prevention care bundle.