Paper Example on Efficiency of Prophylaxis in the Prevention of Post-operative Atrial Fibrillation

Introduction

Atrial fibrillation is most common in the recent word because of the increased number of heart patients. After surgeries, it is most probable for the parents to develop Post-operative atrial fibrillation (POAF). POAF is on the other hand associated with a longer stay in hospitals, increased hospital bills and post-operative complications that may subsequently follow. Studies indicate the POAF is multifactorial, but the concise pathophysiology is not yet known. For prevention of POAF, beta blockers are recommended by medical guidelines as the first line preventive therapy for atrial fibrillation. In cases where beta-blockers are contraindicated, amiodarone is recommended. However, there still lacks evidence on the efficacy of using amiodarone as compared to beta-blockers in POAF prevention. Over the years, studies have been established to compare the potency of prophylaxis in prevention of atrial fibrillation after cardiac surgical procedures. This paper will focus on analyzing several meta-analysis studies that were carried out to find out the efficiency of prophylaxis in the prevention of POAF.

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Piccini et al., (2016), researched to compare the effectiveness of using pharmacotherapies to prevent AF after cardiac surgery showed some positive results on pharmacotherapies effectiveness. The study determined the use and variation of POAF prevention and furthered an assessment done on the comparative effectiveness of alternative drugs that are used to prevent POAF. Piccini et al., (2016), in their study, indicated that POAF is most common and affects about 25%-40% of the patients who undergo coronary artery bypass grafting (CABG). In the CABG patients, there is a considerable morbidity and mortality rate and other conditions such as renal and heart failure. The main aim of Piccini and colleagues was to examine the preoperative pharmacotherapy effectiveness compared to the prevention of AF after surgery. From the results of the study, it was found that 30% of the patients who underwent cardiac surgery had sustained AF post-surgery. Most of the patients developed postoperative AF. Also, the researchers established that AF is still a common complication in CABG patients. It is indicated that the researchers were unable to demonstrate the effectiveness of the commonly used AF prophylaxis agents in lowering the rates of postoperative AF as compared to alternatives in preventing AF or no treatment at all. Professional guidelines state that beta-adrenergic blocking agents should be used as the first line treatment to prevent post-op AF. However, according to Picccini et al., (2016), despite the recommendation, the results of the research indicated that there was no significant reduction of AF after surgery. It is also established that withdrawal of beta-blockers therapy contributed to the ineffectiveness of beta-blockade. In the study, it is concluded that none of the available preoperative options are fully effective and free from adverse events.

Skiba et al., (2013), researched the effectiveness of using metoprolol during cardiac surgery. The study focused on investigating the pharmacological efficacy of prophylaxis to prevent AF using amiodarone in combination with metoprolol and use of metoprolol solely. The study had three treatment groups, the controlled group, and single-blind and randomized patients who were undergoing elective cardiac surgery. The results from the research indicated that when metoprolol is combined with amiodarone during surgery showed a remarkable incidence of side effects such as bradycardia. The study also indicated that using metoprolol singly during cardiac surgery, and there was a significant reduction in the rate of AF. Therefore, it is evident that using perioperative metoprolol is effective in preventing AF. Skiba et al., (2016), concluded that it would be more reasonable to use perioperative metoprolol alone for prevention of AF as a combination of metoprolol and amiodarone would bring adverse events that can harm a patient.

Zhu et al., (2012), carried out a meta-analysis as from January 1990 to October 2011 on amiodarone versus beta-blockers. The study aimed at finding out whether beta-blocker and amiodarone are effective and safe in preventing POAF, or if either of them is superior to the other in POAF prevention. The researchers used several credible sources to find out relevant information about the study goal. The researchers used random-effects model for cases where there was a significant diversity between trials and where the diversity was negligible, a fixed-effects model was employed. The researchers also analyzed subgroups and sensitivities. According to the research results, amiodarone group and beta-blocker group did not show any significant difference in the occurrence of atrial fibrillation or on the hospital stay period. With the subgroup that was analyzed, they were separated by different beta-blockers, and they presented a great improvement POAF when compared with propranolol group. There were no remarkable differences n adverse events Post-op. Zhu et al., (2016), concluded in their study that Post-Op hospital stay was similar in the beta-blocker and amiodarone groups. Therefore, as the aim of the study was to find whether one was superior to the other and if one either was more effective, it is established that both the prophylaxes were ineffective in Post-op cardiac patients.

A survey was carried out in the year 2004 by Auer et al., to test whether there is superiority in using oral drugs to prevent POAF to the utilization of placebo after cardiac procedures. Auer et al., (2004), also targeted to find whether there is any significant difference in favor of using a placebo or active drugs in preventing POAF. The research used random double-blinded and placebo-controlled groups of patients who were undergoing cardiac surgery without heart failure. The first group was given amiodarone in combination with metoprolol, and another group was given metoprolol alone and another placebo only. According to Auer et al., (2004), patients who received a combination of metoprolol and amiodarone and those who received sotalol presented a significant reduction in AF frequency as compared to those who received placebo. Patients who received metoprolol alone reduced the frequency of AF by approximately 13%. Also, the researchers indicate that there was no remarkable difference in the treatment effects for the groups that were administered with active drugs. However, adverse events were noted to be similar among the groups. The adverse events included dyspepsia, post-op infections, nausea as well as bradycardia. The study indicated that the placebo group patients had a relatively longer hospital stay period as compared to the groups that were under active drugs. Those under active drugs had no difference in the hospital stay period. Auer et al., (2004), concluded that using active drugs prophylaxis with amiodarone, sotalol or a combination of amiodarone and metoprolol may significantly reduce the frequency of POAF. The research concluded that prophylaxis using metoprolol solely resulted to reduction of POAF.

Conclusion

In summary, it is evident that post-op prophylaxis is the best strategy in the prevention of AF frequency. Using preoperative options is not fully effective, and in turn, there are significant adverse events that can harm the health of the patient. On the other hand, using perioperative strategy to prevent AF, metoprolol alone is the effective way of preventing the frequency of AF because combining metoprolol and amiodarone would bring adverse events that are harmful. Another study indicated that using amiodarone and beta blocker in post-op patients is ineffective and therefore not recommended for Post-Op patients. The best strategy for the prevention of AF is the use of active drugs such as metoprolol in post-op patients is the most effective.

References

Auer, J., Weber, T., Berent, R., Puschmann, R., Hartl, P., Ng, C., . . . Eber, B. (2004). A comparison between oral antiarrhythmic drugs in the prevention of atrial fibrillation after cardiac surgery: The pilot study of prevention of postoperative atrial fibrillation (SPPAF), a randomized, placebo-controlled trial. American Heart Journal, 147(4), 636-643. doi:http://dx.doi.org/10.1016/j.ahj.2003.10.041

Piccini, J. P., Zhao, Y., Steinberg, B. A., He, X., Mathew, J. P., Fullerton, D. A., & ... Peterson, E. D. (2013). Comparative effectiveness of pharmacotherapies for prevention of atrial fibrillation following coronary artery bypass surgery. American Journal Of Cardiology, 112(7), 954-960. doi:10.1016/j.amjcard.2013.05.02

Skiba, M. A., Pick, A. W., Chaudhuri, K., Bailey, M., Krum, H., Kwa, L. J., & Rosenfeldt, F. L. (2013). Prophylaxis against atrial fibrillation after cardiac surgery: Beneficial effect of perioperative Metoprolol. Heart, Lung & Circulation, 22(8), 627-633. doi:10.1016/j.hlc.2012.12.017

Zhu, J., Wang, C., Gao, D., Zhang, C., Zhang, Y., Lu, Y., & Gao, Y. (2012). Meta-analysis of Amiodarone versus beta-blocker as a prophylactic therapy against atrial fibrillation following cardiac surgery. Internal Medicine Journal, 42(10), 1078-1087. doi:10.1111/j.1445-5994.2012.02844