Doing simple things well: Practice Advisory Implementation Reduces Atrial Fibrillation after Cardiac Surgery

Abstract Objectives We aimed to adapt a practice advisory for the prevention of atrial fibrillation after cardiac surgery (AFACS) recently published in this journal into our local perioperative protocols, implementing the recommendations with a focus on early postoperative (re)introduction of β-blockers and overcoming frequent guideline implementation barriers. Design Development of a prevention care bundle and repeated audit following a model of improvement approach with retrospective analysis. Setting Single center (tertiary academic hospital). Participants 384 patients in two cohorts of consecutive patients undergoing open cardiac surgery, before and after hospital wide implementation of a care bundle. Interventions After auditing the standard of care in our center, an AFACS prevention care bundle was designed and implemented, consisting of a graphical tool with five 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. Measurements and main results Significantly more patients received postoperative β-blockers after care bundle implementation (82.7% pre- vs 91.3% post-bundle, p=0.019) with a higher proportion on day 1 (36.7% pre- vs 67% post-bundle, p Conclusion Introduction of an AFACS prevention care bundle improved adherence to current guidelines with regards to early β-blocker administration and significantly reduced incidence of atrial fibrillation after cardiac surgery.