Sunday , December 5 2021

Postoperative control finds Afib in discharged patients



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Patients who have had heart surgery appear to be at risk for atrial fibrillation (Afib) after being discharged home, even though they have not had Afib before and therefore need to be followed up, the researchers advised.

Among patients with a 24-hour monitoring patch, it lasted at least 6 minutes in 19.6% of Afib patients detected with 1.7% of patients receiving normal care over 30 days.P<0.001), reported Dr. Subodh Verma of the University of Toronto in Canada.

“The number of patients on screen to detect atrial fibrillation in that cohort was six,” Verma said at a press conference at the American Heart Association (AHA) virtual meeting.

“In patients who have undergone heart surgery – with coronary artery bypass graft surgery, valve replacement or combination – and no history of pre-operative or pre-discharge fibrillation with a high risk of stroke, continuous rhythm control strategy “he said.

However, controversial researcher Ben Freedman, PhD, PhD, PhD at the Heart Research Institute in Sydney (Australia), has warned that without the research that informs what to do with the information, the results are difficult to use.

“We find people who are being monitored and people with these atrial fibrillation crises and are being put on anticoagulants, with no evidence that it benefits them,” he said. “If you really want to look for these people, we’d have to do a big randomized multicenter controlled test, if we could … Otherwise, we’re knowing what we don’t know what to do.”

Asked for his answer, Verma said MedPage Today“We are not creating patients, but we are trying to find ways to identify people who may be at higher risk, who are not otherwise identified. Remember, they are patients who did not have atrial fibrillation before surgery or before discharge.

“It’s a question that cardiologists deal with,” Verma continued. “In a patient at high risk of stroke – CHADS-VASc [congestive heart failure, hypertension, age, diabetes, previous stroke, vascular disease] the score was 4. Would a surgeon happily discharge if the patient is not in anticoagulation, does this risk of atrial fibrillation disappear, or is atrial fibrillation continuous and hidden? “

“I think that’s clinically significant if you don’t have atrial fibrillation in the hospital after heart surgery, which doesn’t mean it’s the first step in helping you emphasize the risk of constant atrial fibrillation. It also lays the groundwork for the second part of the question, which is anticoagulation. whether or not it is beneficial to conduct a trial to reduce the risk of stroke, ”Verma said.

“From a clinical perspective, what this study tells me is that for patients who have not been hospitalized who have not started anticoagulation or who have not had atrial fibrillation, I would have a low threshold for monitoring these patients and recognizing periods of unrecognized atrial fibrillation,” he noted.

The incidence of Afib is reported to be 50% after cardiac surgery, with most of these studies examining cases within 3 or 5 days of surgery before discharge and what happens after the patient is sent. the house is not normally inspected, Verna explained.

For the study, his team followed 336 patients treated at eight medical centers in Canada who were undergoing heart surgery. Participants had no history of Afib prior to surgery and believed they were at risk for stroke, including heart health, age, and medical history.

A total of 163 patients were given a 24-hour, 24-hour real-time heart rate monitor using a patch-based monitor used on the chest; the remaining 173 participants were assigned to the control group to receive regular 30-day care, which did not involve a scheduled heart rate test / electrocardiogram evaluation unless medically necessary.

Disclosures

The research was funded by the Heart and Stroke Foundation of Canada with unlimited grants from Bristol Myers Squibb (BMS), Pfizer and Boehringer Ingelheim.

Verma introduced important relationships with Abbott, Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, BMS, Eli Lilly, HLS Therapeutics, Janssen, Merck, Novartis, Novo Nordisk, Pfizer, PhaseBio, Sanofi and Valeant.

Freedman introduced important relationships with Bayer, BMS / Pfizer, Daiichi-Sankyo, Omron and AliveCor.

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