Faculty Collaboration Database

Atrial fibrillation after coronary surgery: comparison between different health care systems. Int J Cardiol 2002 Mar;82(3):209-18; discussion 218-9

Date

03/26/2002

Pubmed ID

11911907

DOI

10.1016/s0167-5273(01)00622-2

Scopus ID

2-s2.0-0036126425 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

AIMS: No studies have evaluated the influence of management strategies in different health insurance environments on atrial fibrillation (AF). This observational study compared the incidence of and treatment strategies for postoperative AF after primary coronary bypass surgery.

METHODS AND RESULTS: One insurance and one public funded location was compared: University of Michigan Health Center (USA, n=272) and Tampere University Hospital (Finland, n=314). USA patients had more co-morbidities and were treated more aggressively after acute myocardial infarction. More Finns were on beta-blockers both preoperatively (93 vs. 68%, P<0.001) and postoperatively (97 vs. 66%, P<0.001). However, AF was more frequent among Finns (38 vs. 29%, P=0.037) and present on 4.6% of cases when transferred postoperatively. No USA patients had AF at time of discharge. Mean length of stay was 8.6 days at USA, and not affected by AF. The incidence of in-hospital death, strokes and multiorgan failures was similar. Multivariable analysis, adjusted for site and selection biases (propensity analysis) revealed increasing age [OR=1.063 (1.042, 1.084), P<0.0001] and use of radial arteries [OR=2.175 (1.071, 4.417), P=0.032) to be independent predictors to the incidence of postoperative AF.

CONCLUSIONS: We found several major differences in patient selection and treatment strategies among primary coronary bypass patients managed in the two institutions. Despite the marked practice variation, the incidence of postoperative AF was rather similar. Despite routine use of beta-blockers, AF occurred in 29-38% of patients. However, the length of stay was not particularly affected by postoperative AF.

Author List

Majahalme S, Kim MH, Bruckman D, Tarkka M, Eagle KA

Author

Silja Majahalme MD, PhD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenergic beta-Antagonists
Atrial Fibrillation
Coronary Artery Bypass
Delivery of Health Care
Female
Finland
Humans
Incidence
Length of Stay
Male
Middle Aged
Patient Selection
Postoperative Complications
United States