A Prospective Clinical Audit to Strengthen the Clinical Practices Affecting the Incidence of New-onset Atrial Fibrillation after Off-pump Coronary Artery Bypass Grafting

Abstract

Introduction: New-onset Atrial Fibrillation (AF) carries significant morbidity and mortality risk for postoperative patients. Clinical practice guidelines aimed at preventing it are beneficial, with protocols in place to prevent deviations from the standard. Aim: To improve or strengthen the clinical practices that impact the incidence of new-onset AF after off-pump Coronary Artery Bypass Grafting (CABG). Materials and Methods: The present prospective clinical audit was conducted in the Department of Cardiac Anaesthesiology, Bhanubhai Madhuben Patel Cardiac Centre, Bhaikaka University, Anand, Gujarat, India, from January 2021 to June 2021. Study included 50 consecutive patients undergoing off-pump CABG surgery. The monitored standards included the continuation of beta-blocker therapy in the preoperative period, restarting them in the immediate postoperative period, and maintaining serum potassium (S.K+) within the range of 3.5-5.5 mEq/L. The incidence of AF was also noted. The data were analysed using Microsoft Excel. Results: The audit included a total of 50 patients, with 36 males with a mean age of 58.72 years, and 14 females with a mean age of 60.07 years. Preoperative beta-blocker/Calcium Channel Blocker (CCB) therapy on the day of surgery was administered to 45 (90%) patients, while restarting beta-blockers in the immediate postoperative period was done for 49 (98%) patients. S.K+ levels were maintained within the range in 31 (62%) patients. The last standard was reaudited, and compliance was achieved in 39 (78%) patients. New-onset AF occurred in 4 (8%) and 5 (10%) patients in the audit and reaudit samples, respectively. Conclusion: Clinical audit is a process that helps to identify the lacunae in clinical practices that affect patient outcomes. In the current study, clinical audits have aided in measuring compliance with different clinical practices, as per Institutional protocols. They have also assisted in increasing compliance with clinical practices where measured compliance was below the targeted goal.

Keywords

• arrhythmias
• guideline adherence
• hypokalemia
• morbidity
• standards