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Assistant Professor of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, CT; Director, Pharmacoeconomics and Outcomes Studies Group, Hartford Hospital, Hartford, CT
Pharmacoeconomics and Outcomes Research Fellow, School of Pharmacy, University of Connecticut; Department of Pharmacy Services, Hartford Hospital
Pharmacoeconomics and Outcomes Research Fellow, School of Pharmacy, University of Connecticut; Department of Pharmacy Services, Hartford Hospital
Director of Arrhythmia Service and Coronary Intensive Care Unit; Co-Director of Cardiovascular Pharmacology and Arrhythmia Research, Hartford Hospital; Professor of Medicine, School of Medicine, University of Connecticut, Farmington, CT
Cardiothoracic Surgeon, Division of Thoracic Surgery, Hartford Hospital
Statistician, Department of Research Administration, Hartford Hospital
Associate Professor of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, CT; Co-Director, Cardiovascular Pharmacology and Arrhythmia Research, Hartford Hospital
Reprints: C Michael White PharmD, Hartford Hospital, Hartford, CT 06102-5037, fax 860/545-2277, cmwhite{at}harthosp.org
BACKGROUND: Previous studies have shown that post-cardiothoracic surgery atrial fibrillation (AF) increases the risk of hospital length of stay (LOS), overall mortality, pulmonary edema, and need for a balloon pump. A meta-analysis of 2 previous trials showed a nonsignificant reduction in LOS with postoperative ß-blockers but only encompassed 1200 patients, with few valve surgery patients, and neither study used a hospital within the US.
OBJECTIVE: To evaluate the impact of postoperative ß-blockers on LOS and AF. Secondary endpoints of overall mortality, pulmonary edema, and need for an intra-aortic balloon pump (IABP) were also evaluated between groups.
METHODS: This was a prospective cohort evaluation of all patients undergoing cardiothoracic surgery at our institution between October 1999 and October 2003. Patients receiving prophylactic postoperative ß-blockers were matched (1:1) with patients not receiving prophylaxis for age >70 years, valvular surgery, history of AF, gender, and use of preoperative digoxin and ß-blockers.
RESULTS: Patients (n = 1660) receiving postoperative ß-blockade had a reduction in LOS (mean ± SD 10.22 ± 11.38 vs 12.40 ± 15.67; p = 0.001) and AF (23.5% vs 28.4%; p = 0.02). Mortality, pulmonary edema, and need for IABP were reduced by >50% (p < 0.001; p = 0.001; p < 0.001, respectively), while myocardial infarction and stroke were not significantly impacted.
CONCLUSIONS: In this observational cohort study, prophylactic postoperative ß-blocker use was associated with shorter hospital LOS by an average of 2.2 days and a 17.3% lower incidence of AF. It may also be associated with reductions in overall mortality, pulmonary edema, and need for an IABP.
Key Words: atrial fibrillation, ß-blockers, cardiothoracic surgery, coronary artery bypass surgery
Published Online, October 26, 2004. www.theannals.com, DOI 10.1345/aph.1E310
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  N. Echahidi, P. Pibarot, G. O'Hara, and P. Mathieu Mechanisms, Prevention, and Treatment of Atrial Fibrillation After Cardiac Surgery J. Am. Coll. Cardiol., February 26, 2008; 51(8): 793 - 801. [Abstract] [Full Text] [PDF]
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 W. L Baker and C M. White Post-Cardiothoracic Surgery Atrial Fibrillation: A Review of Preventive Strategies Ann. Pharmacother., April 1, 2007; 41(4): 587 - 598. [Abstract] [Full Text] [PDF]
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