Risk-Stratified Evaluation of Amiodarone to Prevent Atrial Fibrillation After Cardiac Surgery

• Published in: The Annals of thoracic surgery Vol. 82; no. 4; pp. 1332 - 1337
• Main Authors: Barnes, Brian J., Kirkland, Erin A., Howard, Patricia A., Grauer, Dennis W., Gorton, Michael E., Kramer, Jeffrey B., Muehlebach, Gregory F., Reed, William A.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2006; Elsevier Science
• Subjects: Amiodarone - economics; Amiodarone - therapeutic use; Anti-Arrhythmia Agents - economics; Anti-Arrhythmia Agents - therapeutic use; Atrial Fibrillation - epidemiology; Atrial Fibrillation - etiology; Atrial Fibrillation - prevention & control; Biological and medical sciences; Cardiac dysrhythmias; Cardiac Surgical Procedures - adverse effects; Cardiology. Vascular system; Cost-Benefit Analysis; Female; Heart; Hospitalization; Humans; Intensive Care Units; Length of Stay; Male; Medical sciences; Middle Aged; Prevalence; Retrospective Studies; Risk Assessment; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgery of the respiratory system; 24; Antianginal agent; Evaluation; Arrhythmia; Respiratory disease; Coronary vasodilator agent; Atrial fibrillation; Cardiovascular disease; Risk; Amiodarone; Thorax; Cardiac surgery; Antiarrhythmic agent; Iodine Organic compounds; Excitability disorder; Prevention; Heart disease; Risk factor
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2006.04.081

Amiodarone prophylaxis (AMP) reduces the prevalence of postoperative atrial fibrillation (POAF) after cardiac surgery. We investigated the impact of AMP on the frequency and duration of POAF, the intensive care unit and hospital length of stay, and its cost-effectiveness in a risk-stratified cohort. A retrospective, observational analysis of 509 patients who underwent cardiac surgery in 2003 was performed. Data sources included The Society of Thoracic Surgeons national database; medical and medication administration records; and the activity-based cost data from our institution. Risk stratification for POAF was determined using a validated risk index. Cost-effectiveness was determined from the hospital’s perspective. The mean patient age was 63 years, 27% were female, 80% underwent coronary artery bypass grafting, and 29% underwent valve surgery. When a risk-stratified evaluation was made, 50% of patients were at an elevated risk for having POAF develop. When compared with nonprophylaxed patients, those receiving AMP (59%) experienced less POAF (31% vs 22%; p = 0.027) and shorter durations of POAF (4.7 vs 2.7 days; p = 0.025). In the elevated-risk group, AMP clinically (but not significantly) reduced length of stay in the intensive care unit (101 vs 68 hours; p > 0.05) and post-procedural hospital length of stay (9.7 vs. 7.9 days, p > 0.05). In the elevated-risk group, AMP was robustly cost-effective in reducing POAF. Amiodarone prophylaxis reduced the prevalence and duration of POAF. Baseline risk for POAF was a major determinant of the overall cost-effectiveness of AMP. The greatest cost savings with AMP was seen in patients at an elevated risk for POAF. These findings suggest the need for risk stratification when prescribing AMP.