Abstract
New-onset postoperative atrial fibrillation (POAF) following Coronary artery bypass graft (CABG) surgery has been described in up to 15% to 40% of patients in the initial postoperative period. POAF is related with higher mortality, increased hospital resource utilization, postoperative extra ITU hours and hospital days, consequently increasing hospital-related budgets. Beta blocker administration decreases the rate of POAF from 30% - 40% to 12% - 16% after CABG. According to the EACTS (European Association of Cardiothoracic Surgery) guideline December 2006, β-Blockers should routinely be used as the first choice for the prophylaxis of atrial fibrillation (AF) in all patients undergoing cardiac surgery, if not contraindicated (IB). To compare the contemporary practice with the recommended standard retrospective data of consecutive 400 patients treated with isolated CABG between July 2015 and June 2017 were collected. Those patients who received β-blockers on the day of surgery or the following morning (Continued and Restarted on 1st POD) met the standard guidelines. Thus, according to the data (12% + 20%) 32% of the patients met the standard. To compare the rate of Postoperative Atrial fibrillation, we divided the patients into two groups. Group A, who followed the guideline (128 patients) and Group B, who resumed β-Blockers 48 hours onwards (272 Patients). In group A, only 8 patients developed postoperative AF whereas in group B 88 patients developed postoperative AF which is also statistically significant (P β-blockers use at perioperative period.
Highlights
Beta blocker administration decreases the rate of postoperative atrial fibrillation (POAF) from 30% - 40% to 12% - 16% after Coronary artery bypass graft (CABG)
According to the standard guidelines all patient undergoing CABG should receive β-blockers on immediate postoperative period, which is within 24 hours. β-Blockers were continued peri-operatively only in 12% patients
In patients undergoing CABG, the constant usage of β-blockers is associated with a lesser risk of long-term mortality
Summary
In the European Society of Cardiothoracic Surgery 2006 guidelines, the perioperative use of β-Blockers is suggested as the first choice in all patients undergoing CABG, unless otherwise contraindicated. The 2004 ACC/AHA guidelines update on CABG gave a class I recommendation to preoperative or initial postoperative beta blocker therapy in patients without a contraindication [4]. If the patient is on β-Blockers, this must be continued up to the morning of surgery and restarted on the first postoperative day [5]. Our audit objective was to find out any perioperative period in which patient was not on β-Blockers, if there was any, to compare with the standard
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