Buerge Martina, Magboo Rosalie, Wills Dylan, Karpouzis Ioannis, Balmforth Damian, Cooper Paul, Roberts Neil, O'Brien Ben
Department of Perioperative Medicine, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.
Department of Perioperative Medicine, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.
J Cardiothorac Vasc Anesth. 2020 Nov;34(11):2913-2920. doi: 10.1053/j.jvca.2020.06.078. Epub 2020 Jul 3.
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 β-blockers and overcoming frequent guideline implementation barriers.
Development of a prevention care bundle and repeated audit after a model of improvement approach with retrospective analysis.
Single center (tertiary academic hospital).
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.
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.
Significantly more patients received postoperative β-blockers after care bundle implementation (82.7% pre- v 91.3% post-bundle, p = 0.019), with a higher proportion on day 1 (36.7% pre- v 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 75- years and for isolated aortic valve and coronary artery bypass graft surgery.
An AFACS prevention care bundle improved adherence to current guidelines with regard to early β-blocker administration and significantly reduced the incidence of atrial fibrillation after cardiac surgery.
作者旨在将近期发表于本杂志的心脏手术后预防心房颤动（AFACS）的实践指南改编为作者所在机构的围手术期方案，实施相关建议，重点是术后早期重新使用β受体阻滞剂并克服常见的指南实施障碍。
采用改进方法模型并进行回顾性分析，制定预防护理包并进行反复审核。
单中心（三级学术医院）。
在全院实施护理包之前和之后，连续接受心脏直视手术的2组共384例患者。
在审核作者所在中心的护理标准后，设计并实施了AFACS预防护理包，其中包括一个基于术后早期现有证据的包含5个支柱的图形工具。对工作人员进行了多学科教学和培训，并在实施期后进行了第二次审核。
护理包实施后，接受术后β受体阻滞剂治疗的患者显著增多（实施前为82.7%，实施后为91.3%，p = 0.019），第１天的比例更高（实施前为36.7%，实施后为67%，p < 0.001），表明采用成功。AFACS的发生率从35.4%显著降至23.3%（p = 0.009），在65至75岁年龄组以及单纯主动脉瓣和冠状动脉搭桥手术中下降尤为明显。
AFACS预防护理包提高了对早期使用β受体阻滞剂的现行指南的依从性，并显著降低了心脏手术后心房颤动的发生率。
