Implementation of a prevention care bundle reduces the incidence of atrial fibrillation after cardiac surgery: a single-centre study result

Abstract

Atrial fibrillation (AF) is a common adverse event after cardiac surgery affecting approximately 30-50% of patients. This prolongs the patient's hospital length of stay and could lead to significant morbidity. The use of an atrial fibrillation after cardiac surgery (AFACS) prevention care bundle has shown significant reduction in the incidence of AF.1 We adopted and implemented the AFACS prevention care bundle in our centre with the aim of early beta-blocker administration and reducing our local AF incidence. The baseline data collection was performed retrospectively for 6 weeks from June to July 2022. Utilising the Plan-Do-Study-Act (PDSA) cycle, we implemented the AFACS prevention care bundle to the cardiac intensive care unit, high-dependency unit, and the cardiothoracic surgical wards in August 2022. Multiple teaching sessions to all the staff (surgeons, intensivists, nurses, and pharmacists) were done to increase uptake. Reminders were sent via emails to all the personnel involved and posters were made available in every bed area to serve as a visual prompt. A snapshot audit during the implementation was conducted and regular feedback was given to staff. A prospective post-implementation audit was conducted for 6 weeks to reassess the incidence of AF and bundle adherence. Descriptive statistics was used for analysis. A total of 33 patients (mean age 66 yr) were included in the baseline audit. Among them, 27 patients (8%) were male, and 20 patients (60.1%) underwent coronary artery bypass graft (CABG). However, 46 patients (mean age 67 yr) were included in post-implementation audit. The number of male patients were 39 (84.8%) and 24 of them (52.2%) underwent CABG. We found an increase in the number of patients who received postoperative beta-blocker (baseline: n=30 90.9%]; post-implementation: n=44 95.7%]) and an increase in the early beta-blocker administration (baseline: n=24 72.7%]; post-implementation: n=41 89.1%]) indicating bundle adherence. Overall, a 12.9% reduction (baseline: n=10 30.3%]; post-implementation: n=8 17.4%]) in the AFACS incidence was found within 2 months of implementation. Challenges identified in the implementation were engagement from staff and lack of time for data collection. The introduction of AFACS prevention care bundle and adherence to the bundle has helped reduce our local AF incidence. Challenges identified will be addressed in the next PDSA cycle to further improve bundle adherence.