Abstract 133: Outcomes Associated With Perioperative Amiodarone in Cardiac Surgery Patients Receiving Metoprolol

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Auras R Atreya ◽  
Aruna Priya ◽  
Mihaela S Stefan ◽  
Quinn R Pack ◽  
Tara Lagu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Treated Group ◽  
Matched Cohort ◽  
Elective Cardiac Surgery ◽  
Randomized Controlled Studies ◽  
Post Operative Atrial Fibrillation ◽  
Risk Patients

Background: Post-operative atrial fibrillation (POAF) after cardiac surgery occurs frequently and the guidelines make a Class I recommendation for peri-operative betablocker use and a Class IIa recommendation for amiodarone use in high risk patients to reduce length of stay and mortality. Our aim was to study the association between perioperative amiodarone use and clinical outcomes in patients already receiving metoprolol, in a real-world cohort. Methods: Using the PREMIER, Inc. data warehouse, we identified patients ≥18 years without atrial fibrillation at baseline, who underwent elective cardiac surgery during years 2013-2014. We included patients with conditions replicating prior randomized controlled studies. We then excluded all patients not receiving metoprolol. Perioperative amiodarone use was defined as administered on the day of surgery or prior to surgery within the same hospitalization. After propensity matching, we compared outcomes for patients receiving perioperative amiodarone + metoprolol vs. those who received only metoprolol. The primary outcome was POAF and secondary outcomes were in-hospital mortality, length of stay and 1 month readmission among survivors. Results: Among 4351 patients who underwent cardiac surgery and received metoprolol at 212 hospitals, 997 (23%) were treated with perioperative amiodarone. We matched 928 (94%) of perioperative amiodarone treated group based on the propensity score. Table 1 shows baseline characteristics and outcomes of interest in the propensity matched cohort. Median age was 66 years and 74% were male. The propensity matched cohort was well balanced on type of surgery and comorbidities and some imbalances remained in demographic variables. After adjusting for unbalanced factors in the matched cohort, perioperative amiodarone+ metoprolol was associated with reduction in POAF (ARR 5.1%; RR 0.81, 95% CI 0.69-0.95). There were no differences in in-hospital mortality, length of stay, 1 month readmission or cost of hospitalization. Conclusions: In this large cohort of propensity matched patients undergoing elective cardiac surgery, perioperative amiodarone use was associated with a modestly significant reduction in POAF rates, but there were no significant relationships with mortality, length of stay, 1 month readmission or costs.

Abstract 132: Association Between Perioperative Amiodarone and Postoperative Atrial Fibrillation Following Cardiac Surgery

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Auras R Atreya ◽  
Aruna Priya ◽  
Mihaela S Stefan ◽  
Quinn R Pack ◽  
Tara Lagu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Ventricular Arrhythmias ◽  
Artery Bypass ◽  
Postoperative Atrial Fibrillation ◽  
Randomized Controlled Studies ◽  
Hospitalization Costs

Background: Amiodarone effectively reduces the incidence of postoperative atrial fibrillation (POAF) in randomized trials and guidelines give a Class IIa recommendation for its use in high risk patients to improve outcomes; but little is known about its effectiveness to prevent POAF in routine clinical practice. Our aim was to determine the association between perioperative amiodarone use and clinical outcomes in a real-world cohort. Methods: We identified patients aged ≥18 years without atrial fibrillation at baseline, who underwent elective coronary artery bypass surgery ± heart valve surgery in a hospital that contributed to PREMIER, Inc. data warehouse during 2013-2014. We excluded patients to replicate patients enrolled in prior randomized controlled studies. Perioperative amiodarone use was defined as receipt of amiodarone on the day of surgery or prior to surgery within the same hospitalization. We used propensity scores to match patients who received perioperative amiodarone to patients who did not, and compared outcomes. Our primary outcome was POAF (not present on admission). Secondary outcomes included in-hospital mortality, 1 month-readmission among survivors, length of stay and cost. Results: We examined 12,758 patients free of AF admitted at 235 hospitals, of which 2191 (17%) were treated with perioperative amiodarone. Baseline characteristics were well matched after propensity scoring. (Table 1) After adjustment, receipt of amiodarone was associated with reduction in POAF in the matched cohort (ARR 5.6%; RR 0.83, 95% CI 0.75-0.92) but was associated with greater risk of ventricular arrhythmias (OR: 1.66, 95% CI: 1.20 - 2.29), cardiogenic shock (OR: 1.66, 95% CI: 1.13 - 2.42) and higher hospitalization costs ($1,159, 95% CI: $373 - $1,946). There were no differences in in-hospital mortality, length of stay, 1 month readmission. Conclusions: In this large cohort of propensity matched patients undergoing elective cardiac surgery, perioperative amiodarone use was associated with a modest reduction in POAF, but there was no significant relationship with mortality, length of stay, or 1 month readmission. However, we found a small increase in risk of ventricular arrhythmias, cardiogenic shock and costs; findings that have not previously been described and require further evaluation.

scholarly journals Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

Nutrients ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 2103 ◽  
Author(s):  
Aileen Hill ◽  
Kai C. Clasen ◽  
Sebastian Wendt ◽  
Ádám G. Majoros ◽  
Christian Stoppe ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Organ Dysfunction ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Organ Function

Background: Cardiac surgery is associated with oxidative stress and systemic inflammation, which both contribute to postoperative organ dysfunction. Vitamin C is a pleiotropic, antioxidant, and potentially organ-protective micronutrient. Past clinical trials and meta-analyses have focused predominantly on occurrence of postoperative atrial fibrillation. Therefore, we investigated the influence of perioperative vitamin C administration on clinically relevant parameters closer related to the patient’s recovery, especially organ function, and overall outcomes after cardiac surgery. Methods: Randomized controlled trials (RCTs) comparing perioperative vitamin C administration versus placebo or standard of care in adult patients undergoing cardiac surgery were identified through systematic searches in Pubmed, EMBASE, and CENTRAL on 23 November 2018. Published and unpublished data were included. Assessed outcomes include organ function after cardiac surgery, adverse events, in-hospital mortality, intensive care unit, and hospital length-of-stay. Data was pooled only when appropriate. Results: A total of 19 RCTs with 2008 patients were included in this meta-analysis. Vitamin C significantly decreased the incidence of atrial fibrillation (p = 0.008), ventilation time (p < 0.00001), ICU length-of-stay (p = 0.004), and hospital length-of-stay (p < 0.0001). However, on average, vitamin C had no significant effects on in-hospital mortality (p = 0.76), or on the incidence of stroke (p = 0.82). High statistical heterogeneity was observed in most analyses. Conclusions: Vitamin C impacts clinically and economically important outcomes, such as ICU and hospital length-of-stay, duration of mechanical ventilation and lowers the incidence of atrial fibrillation. Due to missing reports on organ dysfunction, this meta-analysis cannot answer the question, if vitamin C can improve single- or multiorgan function after cardiac surgery.

The Prognostic Potential of Atrial Natriuretic Peptide on the Development of Post-Operative Atrial Fibrillation after Cardiac Surgery

2021 ◽  
Author(s):  
Felix Hofer ◽  
Andreas Hammer ◽  
Matthias Steininger ◽  
Niema Kazem ◽  
Lorenz Koller ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Atrial Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Strong Association ◽  
Crude Odds Ratio ◽  
Elective Cardiac Surgery ◽  
Net Reclassification Improvement ◽  
Post Operative Atrial Fibrillation ◽  
Atrial Natriuretic

Background: Post-operative atrial fibrillation (POAF) represents a common complication after cardiac surgery associated with major adverse events and poor patient-outcome. Tools for risk stratification of this arrhythmia remain scarce. Atrial-natriuretic peptide (ANP) represents an easily assessable biomarker picturing atrial function and strain – however, its prognostic potential on the development of POAF has not been investigated so far. Methods: Within the present investigation, 314 patients undergoing elective cardiac surgery were prospectively enrolled. Preoperative MR-proANP values were assessed before the surgical intervention. Patients were followed prospectively and continuously screened for the development of arrhythmic events. Results: A total of 138 individuals (43.9%) developed POAF. Median concentration of MR-proANP were significantly higher within the POAF group (p<0.001). MR-proANP showed a strong association with the development of POAF with a crude odds ratio (OR) of 1.68 per one standard deviation (1-SD; 95%CI 1.31–2.15; p<0.001) which remained stable after comprehensive adjustment for confounders with an adjusted OR of 1.74 per 1-SD (95%CI 1.17–2.58; p=0.006). The discriminatory power of MR-proANP for the development of POAF was validated by the category-free net reclassification improvement (NRI; 0.23 [95%CI: 0.0349 - 0.4193]; p = 0.022) and integrated discrimination increment (IDI; 0.02 [95%CI 0.0046 - 0.0397], p = 0.013). Conclusion: MR-proANP proved to be a strong and independent predictor of the development of POAF. Considering a personalized diagnostic and prognostic pre-operative work up, a standardized pre-operative evaluation of MR-proANP levels might help to identify patients at risk for development of POAF after cardiac surgery.

scholarly journals Atrial fibrillation increases length of stay and cost after cardiac surgery in low risk patients targeted for early discharge

1996 ◽  
Vol 27 (2) ◽  
pp. 309 ◽  
Author(s):  
Mina K. Chung ◽  
Craig R. Asher ◽  
Dawn Dykstra ◽  
Josephine Dimengo ◽  
Monica Weber ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Early Discharge ◽  
Low Risk ◽  
Risk Patients

Epicardial Adipose Tissue and Postoperative Atrial Fibrillation

2021 ◽  
Author(s):  
Petraglia Laura ◽  
Conte Maddalena ◽  
Comentale Giuseppe ◽  
Cabaro Serena ◽  
Campana Pasquale ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Cardiac Surgery ◽  
Epicardial Adipose Tissue ◽  
Perioperative Period ◽  
Postoperative Atrial Fibrillation ◽  
Serum Samples ◽  
Monocyte Chemoattractant Protein 1 ◽  
Elective Cardiac Surgery ◽  
Increased Risk

Abstract Background. Atrial fibrillation (AF) often occurs after cardiac surgery and is associated to increased risk of stroke and mortality. Several evidence support the important role of inflammation in the pathogenesis of postoperative atrial fibrillation (POAF). It is known that an increased volume and a pro-inflammatory phenotype of epicardial adipose tissue (EAT) are both associated with AF onset in non surgical context. In the present study, we aim to evaluate whether also POAF occurrence may be triggered by an exalted production of inflammatory mediators from EAT.Methods. The study population was composed of 105 patients, with no history of paroxysmal or permanent AF, undergoing elective cardiac surgery. After clinical evaluation, all patients performed an echocardiographic study including the measurement of EAT thickness. Serum samples and EAT biopsies were collected before surgery. Levels of 10 inflammatory cytokines were measured in serum and EAT conditioned media. After surgery, cardiac rhythm was monitored for 7 days.Results. Forty-four patients (41.3%) developed POAF. As regard to cardiovascular therapy, only statin use was significantly lower in POAF patients (65.1% vs. 84.7%; p-0.032). Levels of Monocyte Chemoattractant Protein-1 (MCP-1), in both serum and EAT, were significantly higher in POAF patients (130.1 pg/ml vs. 68.7 pg/ml; p = < 0.001; 322.4 pg/ml vs. 153.4 pg/ml; p = 0.028 respectively). EAT levels of IL-6 were significantly increased in POAF patients compared to those in sinus rhythm (126.3 pg/ml vs. 23 pg/ml; p = < 0.005).ConclusionHigher EAT levels of IL6 and MCP1 are significantly associated with the occurrence of POAF. Statin therapy seems to play a role in preventing POAF. These results might pave the way for a targeted use of these drugs in the perioperative period.

Abstract 45: Thrombolytic Treatment for In-Hospital Ischemic Strokes in United States

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Tenbit Emiru ◽  
Malik M Adil ◽  
Adnan I Qureshi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Clinical Characteristics ◽  
The United States ◽  
Treated Group ◽  
Hospital Charges ◽  
Thrombolytic Treatment

BACKGROUND: Despite the recent emphasis on protocols for emergent triage and treatment of in-hospital acute ischemic stroke, there is little data on rates and outcomes of patients receiving thrombolytics for in-hospital ischemic strokes. OBJECTIVE: To determine the rates of in-hospital ischemic stroke treated with thrombolytics and to compare outcomes with patients treated with thrombolytics on admission. DESIGN/METHODS: We analyzed a seven-year data (2002-2009) from the National Inpatient Survey (NIS), a nationally representative inpatient database in the United States. We identified patients who had in-hospital ischemic strokes (defined by thrombolytic treatment after one day of hospitalization) and those who received thrombolytics on the admission day. We compared demographics, baseline clinical characteristics, in hospital complications, length of stay, hospitalization charges, and discharge disposition, between the two patient groups. RESULT: A total of 18036 (21.5%) and 65912 (78.5%) patients received thrombolytics for in-hospital and on admission acute ischemic stroke, respectively. In hospital complications such as pneumonia (5.0% vs. 3.4%, p=0.0006), deep venous thrombosis (1.9% vs. 0.6%, p<0.0001) and pulmonary embolism (0.8% vs. 0.4%, p=0.01) were significantly higher in the in-hospital group compared to on admission thrombolytic treated group. Hospital length of stay and mean hospital charges were not different between the two groups. Patients who had in-hospital strokes had had higher rates of in hospital mortality (12.1% vs. 10.6%, p=0.02). In a multivariate analysis, in-hospital thrombolytic treated group had higher in-hospital mortality after adjustment for age, gender and baseline clinical characteristics (odds ratio 0.84, 95% confidence interval 0.74-0.95, p=0.008). CONCLUSION/RELEVANCE: In current practice, one out of every five acute ischemic stroke patients treated with thrombolytics is receiving treatment for in-hospital strokes. The higher mortality and complicated hospitalization in such patients needs to be recognized.

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