Amiodarone Protocol Provides Cost-Effective Reduction in Postoperative Atrial Fibrillation

Mehaffey, J. Hunter; Hawkins, Robert B.; Byler, Matthew R.; Smith, J.; Kern, John A.; Krön, Irving L.; Ailawadi, Gorav; Wanchek, Tanya; Yarboro, Leora T.

doi:10.1016/j.athoracsur.2017.12.029

Cited by 17 publications

(12 citation statements)

References 26 publications

(27 reference statements)

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“…In their paper in this issue, Mehaffey and colleagues [6] present supportive evidence in favor of the use of amiodarone for preventing POAF. It is a retrospective study, performed using an administrative database that only covers the index hospitalization; as such, it is subject to its limitations despite the advanced statistical techniques used.…”

Section: Invited Commentarymentioning

confidence: 91%

Invited Commentary

Mandal

2018

The Annals of Thoracic Surgery

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Section: Invited Commentarymentioning

confidence: 91%

Invited Commentary

Mandal

2018

The Annals of Thoracic Surgery

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“…23 This mirrors data suggesting postoperative atrial fibrillation affects early costs, but only for the first year, as demonstrated in a costeffectiveness analysis by Mehaffey and colleagues 24 and others. 25,26 The limitations of this study include its single-center retrospective nature, which is susceptible to selection bias and precludes demonstration of causality. These patients represent a typical academic cardiac operation practice and may not be applicable to all populations.…”

Section: Commentmentioning

confidence: 99%

Impact of Complications After Cardiac Operation on One-Year Patient-Reported Outcomes

Mehaffey

Hawkins

Charles

et al. 2020

The Annals of Thoracic Surgery

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“…However, the side effects of existing antiarrhythmic drugs are influencing the clinical decision. A recent study described a prophylactic protocol with intravenous amiodarone for 14 days or until the patient is discharged (26). Unfortunately, the adverse events (severe bradycardia and heart block) could be serious, especially in those with degenerative aortic disease (26).…”

Section: Study Limitationmentioning

confidence: 99%

Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement

Iliescu¹

2018

Anatol J Cardiol

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ObjectivePostoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, with increased risk of stroke and high mortality. Our aim was to identify patients at risk and to design a model that could predict POAF.MethodsIn this single center study, we evaluated 1191 patients requiring isolated surgical aortic valve replacement between January 2000 and June 2014. The patients were followed during the early postoperative period until discharge.ResultsAF occurred in 342 patients (28.71%). Six variables associated with high arrhythmic risk [advanced age, body mass index, tricuspid regurgitation, prolonged ventilation, longer intensive care unit stay, and dilated left atrium (LA; volume ≥35 ml/m2)] were selected to create a multivariate prediction model. This model predicted POAF in 64.7% of cases, with a moderate discriminative power (AUC=0.65; p=0.001; 95% CI, 0.571-0.771). We also developed the CHAID (Chi-square automatic interaction detection) model showing multilevel interactions among risk factors for POAF. Age had the greatest discriminative power, with patients aged >68 years at a higher risk for POAF. In low-risk patients, the subgroup with dilated LA (volume ≥40 ml) was more prone to develop POAF. For the intermediate-risk group, history of AF was the next deciding variable, whereas for the high-risk group, it was tricuspid regurgitation (at least moderate).ConclusionThe multivariate logistic model has an acceptable predictive value. CHAID-derived model is a new tool that could be easily applied to identify patients requiring prophylactic regimens.

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Amiodarone Protocol Provides Cost-Effective Reduction in Postoperative Atrial Fibrillation

Abstract: Implementation of a prophylactic amiodarone protocol significantly reduced risk-adjusted rates of POAF, with a cost savings of $458 per patient. This analysis demonstrates how rigorous quantitative analysis can evaluate the benefits of quality improvement projects.

Cited by 17 publications

References 26 publications

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Invited Commentary

Impact of Complications After Cardiac Operation on One-Year Patient-Reported Outcomes

Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement

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