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

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 (3-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 (3-blockers after care bundle implementation (82.7% prev 91.3% post-bundle, p = 0.019), with a higher proportion on day 1 (36.7% prev 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 75years 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 (3-blocker administration and significantly reduced the incidence of atrial fibrillation after cardiac surgery. (c) 2020 Elsevier Inc. All rights reserved.