Acupuncture after valve surgery is feasible and shows promise in reducing postoperative atrial fibrillation: The ACU-Heart pilot trialCentral MessagePerspective
Kim L. Feingold, PhD,
Judith T. Moskowitz, PhD, MPH,
Christian Elenbaas, MA,
Adin-Cristian Andrei, PhD,
David Victorson, PhD,
Jane Kruse, BSN,
Veronika Grote, MS,
Kaustubha D. Patil, MD,
Tatyana Shafiro, LAC,
Ania Grimone, LAC,
Fang Lin, LAC,
Charles J. Davidson, MD,
Melinda Ring, MD,
Patrick M. McCarthy, MD
Affiliations
Kim L. Feingold, PhD
Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, Chicago, Ill; Address for reprints: Kim L. Feingold, PhD, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Arkes Family Pavilion, Suite 730, Chicago, IL 60611.
Judith T. Moskowitz, PhD, MPH
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill; Osher Center for Integrative Health, Northwestern University Feinberg School of Medicine, Chicago, Ill
Christian Elenbaas, MA
Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, Chicago, Ill
Adin-Cristian Andrei, PhD
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
David Victorson, PhD
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
Jane Kruse, BSN
Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, Chicago, Ill
Veronika Grote, MS
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
Kaustubha D. Patil, MD
Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, Chicago, Ill
Tatyana Shafiro, LAC
Osher Center for Integrative Health, Northwestern University Feinberg School of Medicine, Chicago, Ill
Ania Grimone, LAC
Osher Center for Integrative Health, Northwestern University Feinberg School of Medicine, Chicago, Ill
Fang Lin, LAC
Osher Center for Integrative Health, Northwestern University Feinberg School of Medicine, Chicago, Ill
Charles J. Davidson, MD
Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, Chicago, Ill
Melinda Ring, MD
Osher Center for Integrative Health, Northwestern University Feinberg School of Medicine, Chicago, Ill
Patrick M. McCarthy, MD
Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, Chicago, Ill
Objective: Acupuncture is an effective treatment for arrythmias and postoperative symptoms but has not been investigated after cardiac surgery. Acupuncture After Heart Surgery is a prospective, randomized, controlled pilot trial of daily inpatient acupuncture or standard care after valve surgery with the primary end point being feasibility and secondary end points being reduction in postoperative atrial fibrillation incidence and postoperative symptoms. Methods: A total of 100 patients without a history of atrial fibrillation underwent primary valve surgery via sternotomy and randomized 1:1 to acupuncture (51) or standard care (49). The acupuncture group received daily inpatient sessions starting on postoperative day 1. Postoperative symptoms (pain, nausea, stress, anxiety) were assessed once daily in the standard care group and before/after daily intervention in the acupuncture group. The groups were comparable except for age (acupuncture: 55.6 ± 11.4 years, standard care: 61.0 ± 9.3 years; P = .01). Results: The Acupuncture After Heart Surgery pilot trial met primary and secondary end points. There were no adverse events. An average of 3.8 (±1.1) acupuncture sessions were delivered per patient during a mean hospital stay of 4.6 days (±1.3). Acupuncture was associated with a reduction in pain, nausea, stress, and anxiety after each session (P < .0001), and patients receiving acupuncture had reduced postoperative stress and anxiety across admission compared with standard care (P = .049 and P = .036, respectively). Acupuncture was associated with reduced postoperative atrial fibrillation incidence (acupuncture: 7 [13.7%], standard care: 16 [32.7%]; P = .028), fewer discharges on amiodarone (acupuncture: 5 [9.8%], standard care: 13 [26.5%]; P = .03), and fewer hours in the intensive care unit (acupuncture: 30.3 ± 10.0, standard care: 37.0 ± 22.5; P = .057). Conclusions: Acupuncture after valve surgery is feasible, is well tolerated, and has clinical benefit. The reduction noted in postoperative atrial fibrillation incidence will inform larger trials designed to further investigate the impact of acupuncture on postoperative atrial fibrillation and medical outcomes.
