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Does Prophylaxis against Atrial Fibrillation after Cardiac Surgery Reduce Length of Stay or Hospital Costs?
Author(s) -
Reddy Prabashni
Publication year - 2001
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.21.3.338.34199
Subject(s) - medicine , amiodarone , atrial fibrillation , cardioversion , randomized controlled trial , cardiac surgery , stroke (engine) , sotalol , cardiology , anesthesia , intensive care medicine , mechanical engineering , engineering
Atrial fibrillation (AF) is common after cardiac surgery and may result in stroke, need for permanent pacemaker, hemodynamic instability, and sustained AF. Studies determining the effect of prophylaxis against AF in cardiac surgery on length of stay (LOS) and hospital cost were reviewed. A MEDLINE search from January 1966–November 2000 was conducted using the medical subject heading (MeSH) “atrial fibrillation.” The search was limited to clinical trials in the English language. In five of the seven studies reviewed, the frequency of postoperative AF was significantly reduced with prophylactic amiodarone or sotalol. In only one study were LOS and costs significantly reduced. Whereas there is strong evidence that prophylactic drug therapy reduces the frequency of postoperative AF, there is little evidence of an economic advantage. Future studies are warranted that examine costs beyond initial hospitalization; compare prophylaxis administered selectively to high‐risk patients with prophylaxis administered universally; and compare prophylaxis with the combination of rate control and anticoagulation with cardioversion if AF persists.