A new protocol that could significantly reduce postop setbacks in cardiac patients


atrial fibrillation

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Some exciting news is brewing for patients with cardiac issues. The Minneapolis Heart Institute Foundation (MHIF) has developed a new protocol that may reduce incidents of postoperative atrial fibrillation in patients.

Atrial fibrillation (AF) is a condition in which the upper chambers of the heart contract in a way that's out of sync with the lower chambers, causing an irregular heartbeat and poor blood flow to the body. It can lead to increased risk or blood clots in the heart, stroke and heart failure.

According to the U.S. Centers for Disease Control and Prevention (CDC), up to 6 million Americans have a form of AF, a number which is expected to rise as the population ages. A common form of AF is postoperative atrial fibrillation (POAF), which can result in lengthened hospital stays, complications and mortality.

The MHIF appointed a team, led by principal investigators Timothy Henry, MD, and Craig Strauss, MD, MPH, to investigate whether surgical protocols could be changed in such a way that POAF could be reduced. They reviewed existing literature as well as data from electronic medical records (EMR), which indicated that POAF occurs in nearly 30% of cardiovascular surgery cases. The highest incidences occurred in people older than 70 with left atrial enlargement and hypertension.

The team developed a new protocol and entered into the EMR advising physicians and surgeons to look for patients eligible to receive the prophylactic amiodarone that can treat and prevent AF.

The MHIF launched the new protocol in April 2013. Through the end of 2013 there were 157 elective cardiac surgeries. Of those, some patients were pre-evaluated and treated with amiodarone; some were pre-evaluated but not treated; and the remaining patients were neither pre-evaluated nor treated. The first group had a reduced occurrence of POAF, from an expected 38% to 11%, while the other groups did not experience that reduction.

These preliminary results show that using the new protocol can reduce POAF, offering improved outcomes for the patients. In addition, it can significantly reduce healthcare costs. If the protocol were fully implemented across the study location, it could potentially reduce hospital days associated with POAF by 110 days per year, representing nearly $250,000. Multiply that out across the country, and the healthcare cost savings becomes even more significant.