Assessment of new onset postcoronary artery bypass surgery atrial fibrillation: current practice pattern review and the development of treatment guidelines
Assessment of new onset postcoronary artery bypass surgery atrial fibrillation: current practice pattern review and the development of treatment guidelines
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DOI：
10.1046/j.1365-2710.2002.00383.x
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发表时间：
2002-02-01
影响因子：
2
通讯作者：
Pearson, GJ
中科院分区：
文献类型：
--
作者：
Thompson, AE;Hirsch, GM;Pearson, GJ
背景：QEII 健康科学中心冠状动脉搭桥术后 (CABG) 心房颤动 (AF) 的发生率为 22.5%，平均住院时间比没有出现这种并发症的患者长 5.5 天。适当的药物管理对于预防房颤的潜在发病率非常重要，例如血栓栓塞、充血性心力衰竭、心源性休克和冠状动脉缺血。该项目将 CABG 后 AF 管理的当前实践模式与当地实践模式信念和主要文献证据进行了比较。随后，设计了治疗指南来帮助指导合理的治疗方法。目的：通过制定共识治疗指南，促进冠状动脉搭桥术后房颤的适当治疗策略，并提高当地医生对药物使用结果的认识。设计：分为三个阶段。在第一阶段，对连续三个月内 35 名 CABG 后 AF 患者进行回顾性图表分析，以评估当前的实践模式。还收集并分析了有关该主题的所有已发表的研究。在第二阶段，向当地利益相关者分发了一项药物治疗偏好调查。第三阶段涉及治疗指南的制定和实施。结果：本研究确定了治疗 CABG 后 AF 的高度可变的方法。 CABG 后用于治疗 AF 的药物平均数量为两种（范围 1-4）；所有患者（100%）都服用了心率控制药物，37% 的患者服用了抗心律失常药物。实践模式信念与实际实践之间也存在不匹配。结论：这强化了对一致的治疗方法的需求，并通过当地指南的制定和实施来促进这种方法。
Background: The incidence of postcoronary artery bypass graft (CABG) atrial fibrillation (AF) is 22.5% at the QEII Health Sciences Centre and the mean length of stay is 5.5 days greater than for those patients who do not experience this complication. Appropriate pharmacological management is important to prevent the potential morbidity from AF, such as thromboembolism, congestive heart failure, cardiogenic shock and coronary ischemia. This project compared current practice patterns in the management of post-CABG AF with local practice pattern beliefs and evidence from the primary literature. Subsequently, treatment guidelines were designed to help guide a rationale treatment approach. Objective: To promote appropriate treatment strategies for post-CABG AF and increase local practitioner awareness of drug-use outcomes by developing consensus treatment guidelines.Design: There were three phases. In phase 1, a retrospective chart analysis of 35 post-CABG AF patients over three consecutive months was conducted to assess current practice patterns. All published studies on this subject were also collected and analysed. A survey of pharmacological treatment preferences was distributed to local stakeholders during phase 2. The third phase involved the development and implementation of treatment guidelines.Results: This study identified a highly variable approach to the treatment of post-CABG AF. The mean number of agents used to treat AF post-CABG was two (range 1-4); all patients (100%) were prescribed rate-controlling agents and 37% were prescribed an antiarrhythmic drug. There was also a mismatch between practice pattern beliefs and actual practice.Conclusions: This reinforced the need for a consistent treatment approach that was facilitated with the development and implementation of local guidelines.