Barnes Brian J, Kirkland Erin A, Howard Patricia A, Grauer Dennis W, Gorton Michael E, Kramer Jeffrey B, Muehlebach Gregory F, Reed William A
Department of Pharmacy Practice, School of Pharmacy, The University of Kansas Medical Center, Kansas City, Kansas 66160-7231, USA.
Ann Thorac Surg. 2006 Oct;82(4):1332-7. doi: 10.1016/j.athoracsur.2006.04.081.
Amiodarone prophylaxis (AMP) reduces the prevalence of postoperative atrial fibrillation (POAF) after cardiac surgery. We investigated the impact of AMP on the frequency and duration of POAF, the intensive care unit and hospital length of stay, and its cost-effectiveness in a risk-stratified cohort.
A retrospective, observational analysis of 509 patients who underwent cardiac surgery in 2003 was performed. Data sources included The Society of Thoracic Surgeons national database; medical and medication administration records; and the activity-based cost data from our institution. Risk stratification for POAF was determined using a validated risk index. Cost-effectiveness was determined from the hospital's perspective.
The mean patient age was 63 years, 27% were female, 80% underwent coronary artery bypass grafting, and 29% underwent valve surgery. When a risk-stratified evaluation was made, 50% of patients were at an elevated risk for having POAF develop. When compared with nonprophylaxed patients, those receiving AMP (59%) experienced less POAF (31% vs 22%; p = 0.027) and shorter durations of POAF (4.7 vs 2.7 days; p = 0.025). In the elevated-risk group, AMP clinically (but not significantly) reduced length of stay in the intensive care unit (101 vs 68 hours; p > 0.05) and post-procedural hospital length of stay (9.7 vs. 7.9 days, p > 0.05). In the elevated-risk group, AMP was robustly cost-effective in reducing POAF.
Amiodarone prophylaxis reduced the prevalence and duration of POAF. Baseline risk for POAF was a major determinant of the overall cost-effectiveness of AMP. The greatest cost savings with AMP was seen in patients at an elevated risk for POAF. These findings suggest the need for risk stratification when prescribing AMP.
胺碘酮预防（AMP）可降低心脏手术后房颤（POAF）的发生率。我们在一个风险分层队列中研究了AMP对POAF的发生频率和持续时间、重症监护病房（ICU）住院时间和医院住院时间的影响及其成本效益。
对2003年接受心脏手术的509例患者进行回顾性观察分析。数据来源包括胸外科医师协会国家数据库、医疗和用药记录以及我们机构基于活动的成本数据。使用经过验证的风险指数确定POAF的风险分层。从医院角度确定成本效益。
患者平均年龄为63岁，27%为女性，80%接受冠状动脉旁路移植术，29%接受瓣膜手术。进行风险分层评估时，50%的患者发生POAF的风险升高。与未接受预防的患者相比，接受AMP的患者（59%）发生POAF的情况较少（31%对22%；p = 0.027），且POAF持续时间较短（4.7天对2.7天；p = 0.025）。在高风险组中，AMP在临床上（但无显著差异）缩短了ICU住院时间（101小时对68小时；p>0.05）和术后医院住院时间（9.7天对7.9天，p>0.05）。在高风险组中，AMP在降低POAF方面具有显著的成本效益。
胺碘酮预防降低了POAF的发生率和持续时间。POAF的基线风险是AMP总体成本效益的主要决定因素。在POAF风险升高的患者中，使用AMP节省的成本最大。这些发现表明在开具AMP处方时需要进行风险分层。
