Multidisciplinary quality-improvement measures halved new-onset atrial fibrillation incidence from 34.7% to 16.8% (RR 0.48, p=0.0067) in patients undergoing OPCAB.
Do multidisciplinary quality-improvement measures reduce the incidence of new-onset atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting?
Multidisciplinary quality-improvement measures significantly improved adherence to perioperative AF prevention protocols and halved the incidence of postoperative AF in OPCAB patients.
Effect estimate: RR 0.48; OR 0.38 (95% CI RR 0.29-0.81; OR 0.19-0.74)
Absolute Event Rate: 16.8% vs 34.7%
p-value: p=0.0067
Background New-onset atrial fibrillation (AF) is a frequent complication following cardiac surgery and is associated with significant mortality and morbidity. This audit evaluated adherence to perioperative AF prevention standards and the effect of targeted quality-improvement measures in off-pump coronary artery bypass grafting (OPCAB) patients. Methodology Two prospective audit cycles were performed at the Apollo Imperial Hospitals. Cycle 1 (January to September 2024; n=95 eligible) established baseline compliance with three standards: the continuation of beta-blocker on the morning of surgery, maintenance of perioperative serum potassium at 4. 5-5. 0 mmol/L, and reinstitution of beta-blocker within 12 hours postoperatively. After multidisciplinary interventions (permanent ICU/OR posters, checklist attached to patient records, weekly team meetings, and four-times-daily ward rounds), improvement was assessed in cycle 2 (November 2024 to July 2025; n=101). Bisoprolol was the institutional beta-blocker; ivabradine was used if beta-blockers were contraindicated. Categorical variables were analyzed using the chi-square test or Fisher’s exact test, and relative risk (RR) and odds ratios (OR) were estimated with 95% confidence intervals (CI). Results Preoperative beta-blocker continuation improved from 66. 3% to 94. 1% (p<0. 001). Serum potassium maintenance within target increased from 42. 1% to 81. 2% (p<0. 001). Reinstitution rates were high in both cycles (96. 8% versus 95. 0%, p=0. 72). New-onset AF incidence decreased from 34. 7% to 16. 8% (p=0. 0067; RR: 0. 48 95% CI: 0. 29-0. 81; OR: 0. 38 95% CI: 0. 19-0. 74). Conclusion Structured, multidisciplinary quality-improvement measures significantly improved compliance with AF prevention protocols and were associated with a decrease in postoperative AF incidence by 50% in OPCAB patients. Routine audits and sustained adherence to protocol are recommended.
Rahman et al. (Fri,) conducted a other in Adults aged 18-75 undergoing isolated off-pump coronary artery bypass grafting (OPCAB) without preoperative atrial fibrillation, severe LV dysfunction (EF <30%), redo or combined surgeries, or heart block (n=196). Multidisciplinary quality-improvement measures to improve compliance with perioperative AF prevention protocols (including continuation of beta-blocker on surgery day, maintenance of serum potassium 4.5-5.0 mmol/L, and reinstitution of beta-blockers within 12 hours postoperatively) vs. Baseline compliance before implementation of quality-improvement measures was evaluated on Incidence of new-onset atrial fibrillation after OPCAB surgery (RR 0.48; OR 0.38, 95% CI RR 0.29-0.81; OR 0.19-0.74, p=0.0067). Multidisciplinary quality-improvement measures halved new-onset atrial fibrillation incidence from 34.7% to 16.8% (RR 0.48, p=0.0067) in patients undergoing OPCAB.