Current use of prophylactic strategies for postoperative atrial fibrillation: a survey of Canadian cardiac surgeons.
BACKGROUND
Evidence from multiple trials demonstrates the efficacy of prophylactic beta-blocker, amiodarone, and corticosteroid administration in reducing the incidence of postoperative atrial fibrillation. Despite this information, these interventions remain infrequently or inappropriately utilized. This study was designed to assess the frequency with which these prophylactic strategies are currently being used and to identify concerns and barriers to more widespread application.


METHODS
A link to an online survey was e-mailed to all practicing cardiac surgeons in Canada. Each surgeon was given a unique log-in identification number to complete the survey online through a secure web page.


RESULTS
Surveys were sent to 166 surgeons; 119 completed surveys (72%) were returned. Only 58% of respondents routinely use beta-blockade for prophylaxis. For nonusers, 44% are unconvinced of the evidence for this practice. The routine use of amiodarone among surgeons was 19%. Of the remainder, 43% cited a perceived increased risk of complications as the reason for not using this therapy. An additional 29% considered the therapy was excessively complicated or time consuming. Corticosteroids were routinely used by only one surgeon. Major barriers to use of steroids were unconvincing evidence (76%), a perceived increased risk of wound infection (38%), and hyperglycemia (30%).


CONCLUSIONS
Despite level 1 evidence, the use of beta-blockers, amiodarone, and corticosteroids for prophylaxis of atrial fibrillation among Canadian surgeons remains less than expected. The results of this survey support the need for further clinical trials with robust and clinically relevant outcomes that may further influence surgeons to adopt this practice.
Price
Joel
J
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Tee
Rebecca
R
Lam
Buu-Khanh
BK
Hendry
Paul
P
Green
Martin S
MS
Rubens
Fraser D
FD
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009864:Ontario; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D011336:Probability; D011787:Quality of Health Care; D018570:Risk Assessment; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones; D000889:Anti-Arrhythmia Agents; D000638:Amiodarone