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Society of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anaesthetists Practice Advisory for the Management of Perioperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery.

Publication ,  Journal Article
Muehlschlegel, JD; Burrage, PS; Ngai, JY; Prutkin, JM; Huang, C-C; Xu, X; Chae, SH; Bollen, BA; Piccini, JP; Schwann, NM; Mahajan, A; Ruel, M ...
Published in: Anesth Analg
January 2019

Postoperative atrial fibrillation (poAF) is the most common adverse event after cardiac surgery and is associated with increased morbidity, mortality, and hospital and intensive care unit length of stay. Despite progressive improvements in overall cardiac surgical operative mortality and postoperative morbidity, the incidence of poAF has remained unchanged at 30%-50%. A number of evidence-based recommendations regarding the perioperative management of atrial fibrillation (AF) have been released from leading cardiovascular societies in recent years; however, it is unknown how closely these guidelines are being followed by medical practitioners. In addition, many of these society recommendations are based on patient stratification into "normal" and "elevated" risk groups for AF, but criteria for that stratification have not been clearly defined. In an effort to improve the perioperative management of AF, the Society of Cardiovascular Anesthesiologists (SCA) Clinical Practice Improvement Committee developed a multidisciplinary Atrial Fibrillation Working Group that created a summary of current best practice based on a distillation of recent guidelines from professional societies involved in the care of cardiac surgical patients. An evidence-based set of survey questions was then generated to describe the current practice of perioperative AF management. Through collaboration with the European Association of Cardiothoracic Anaesthetists (EACTA), that survey was distributed to the combined memberships of both the SCA and EACTA, yielding 641 responses and resulting in the most comprehensive understanding to date of perioperative AF management in North America, Europe, and beyond. The survey data demonstrated the broad range of therapies utilized for the prevention and treatment of poAF, as well as a spectrum of adherence to published guidelines. With the goal of improving adherence, a graphical advisory tool was created with an easily accessible format that could be utilized for bedside management. Finally, given that no evidence-based threshold currently exists to differentiate patients at normal risk to develop poAF from those at elevated risk, the SCA/EACTA AF working group created a list of poAF risk factors using expert opinion and based on published risk score models for poAF. This approach allows stratification of patients into risk groups and facilitates adherence to the evidence-based recommendations summarized in the graphical advisory tool. It is our hope that these new additions to the clinical toolkit for the management of perioperative AF will improve the evidence-based care and outcomes of cardiac surgical patients worldwide.

Duke Scholars

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Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

January 2019

Volume

128

Issue

1

Start / End Page

33 / 42

Location

United States

Related Subject Headings

  • Societies, Medical
  • Risk Factors
  • Risk Assessment
  • Practice Patterns, Physicians'
  • Perioperative Care
  • Humans
  • Guideline Adherence
  • Evidence-Based Medicine
  • Consensus
  • Cardiac Surgical Procedures
 

Citation

APA
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Muehlschlegel, J. D., Burrage, P. S., Ngai, J. Y., Prutkin, J. M., Huang, C.-C., Xu, X., … O’Brien, B. (2019). Society of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anaesthetists Practice Advisory for the Management of Perioperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery. Anesth Analg, 128(1), 33–42. https://doi.org/10.1213/ANE.0000000000003865
Muehlschlegel, J Daniel, Peter S. Burrage, Jennie Yee Ngai, Jordan M. Prutkin, Chuan-Chin Huang, Xinling Xu, Sanders H. Chae, et al. “Society of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anaesthetists Practice Advisory for the Management of Perioperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery.Anesth Analg 128, no. 1 (January 2019): 33–42. https://doi.org/10.1213/ANE.0000000000003865.
Muehlschlegel JD, Burrage PS, Ngai JY, Prutkin JM, Huang C-C, Xu X, Chae SH, Bollen BA, Piccini JP, Schwann NM, Mahajan A, Ruel M, Body SC, Sellke FW, Mathew J, O’Brien B. Society of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anaesthetists Practice Advisory for the Management of Perioperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery. Anesth Analg. 2019 Jan;128(1):33–42.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

January 2019

Volume

128

Issue

1

Start / End Page

33 / 42

Location

United States

Related Subject Headings

  • Societies, Medical
  • Risk Factors
  • Risk Assessment
  • Practice Patterns, Physicians'
  • Perioperative Care
  • Humans
  • Guideline Adherence
  • Evidence-Based Medicine
  • Consensus
  • Cardiac Surgical Procedures