Atrial Fibrillation
Summary
To assist clinicians in bringing existing guidelines and best practice recommendations to the bedside, ERAS Cardiac has created a series of "Turnkey Order Sets". These order sets have been created following review of the existing evidence, and provide a guide for implementation of these ERAS elements.
Turnkey Order Set (TKO) Methodology
To assist with implementation of cardiac enhanced recovery after surgery (ERAS), we have created a sample turn key order set (TKO). The order set has been translated by subject matter experts using accumulated evidence, peer-reviewed literature, and current enhanced recovery practices.
Orders derived from Class I or IIA recommendations across all referenced guidelines and consensus manuscripts appear in the TKO in bold type.
Selected orders that were inconsistently Class I or IIA, Class IIB, or supported by evidence published in peer-reviewed journals, were also included in italicized type.
Decisions regarding order inclusion were made based on estimated benefit, risk, cost, implementation complexity, and generalizability. Each of these orders should be considered based on local institutional priorities, resources, practices, and expertise.
The Turnkey Order Set PDF in this module is intended for use by ERAS Cardiac Society Members to assist in building order sets at their own institution. They are permitted to be downloaded.
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ERAS Cardiac VTC Disclaimer:
The VTC, and all included content, is intended to inform ERAS Cardiac Members in a multitude of topics related to enhanced recovery. The information included has been provided by other enhanced recovery experts and should be used for educational purposes only. It is not intended to describe, recommend, or suggest any specific medical practice or intervention, nor should it be considered as formal medical advice or consultation. The ERAS Cardiac Society cannot guarantee that the information on the VTC is accurate or complete in every respect. Therefore, ERAS Cardiac Society is not responsible for any errors or omissions in the content, or medical results that occur with the application of the information obtained while using the VTC. All healthcare professionals should continue to use sound clinical judgment and prescribe therapies based on the best medical knowledge at their disposal.
All the material presented on the VTC is the intellectual property of the ERAS Cardiac Society, its contributors, and its sponsors. Unless explicitly stated, the information, images, audio, video, and other content may not be reproduced (in whole or in part) in any way without the written permission of the ERAS Cardiac Society.
If you have any questions or comments about the ERAS Cardiac VTC, please email: VTC@erascardiac.org
Educational Materials
AFib Turnkey Order Set - Presentation
AFib Turnkey Order Set
References:
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2 Woldendorp K, Farag J, Khadra S, Black D, Robinson B, Bannon P. Postoperative Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis. Ann Thorac Surg. 2021 Dec;112(6):2084-2093. PMID: 33340521.
3 January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, et al; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014 Dec 2;130(23):2071-104. PMID: 24682348.
4 January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019 Jul 9;74(1):104-132. PMID: 30703431.
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10Mitchell LB, Exner DV, Wyse DG, Connolly CJ, Prystai GD, Bayes AJ, et al. Prophylactic Oral Amiodarone for the Prevention of Arrhythmias that Begin Early After Revascularization, Valve Replacement, or Repair: PAPABEAR: a randomized controlled trial. JAMA. 2005;294(24):3093-100. PMID: 16380589.
11 Whitlock RP, Belley-Cote EP, Paparella D, Healey JS, Brady K, Sharma M, et al; LAAOS III Investigators. Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke. N Engl J Med. 2021;384(22):2081-2091. doi: 10.1056/NEJMoa2101897. PMID: 33999547.
12Soletti GJ, Perezgrovas-Olaria R, Harik L, Rahouma M, Dimagli A, Alzghari T, et al. Effect of posterior pericardiotomy in cardiac surgery: A systematic review and meta-analysis of randomized controlled trials. Front Cardiovasc Med. 2022;9:1090102. doi: 10.3389/fcvm.2022.1090102. PMID: 36620644.
13Mitchell LB, Exner DV, Wyse DG, Connolly CJ, Prystai GD, Bayes AJ, et al. Prophylactic Oral Amiodarone for the Prevention of Arrhythmias that Begin Early After Revascularization, Valve Replacement, or Repair: PAPABEAR: a randomized controlled trial. JAMA. 2005;294(24):3093-100. doi: 10.1001/jama.294.24.3093. PMID: 16380589.
14 Gillinov AM, Bagiella E, Moskowitz AJ, Raiten JM, Groh MA, Bowdish ME, et al; CTSN. Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery. N Engl J Med. 2016;374(20):1911-21. doi: 10.1056/NEJMoa1602002. PMID: 27043047.
15 Chatterjee S, Ad N, Badhwar V, Gillinov AM, Alexander JH, Moon MR. Anticoagulation for atrial fibrillation after cardiac surgery: Do guidelines reflect the evidence? J Thorac Cardiovasc Surg. 2023:S0022-5223(23)00275-1. doi: 10.1016/j.jtcvs.2023.03.026. PMID: 37037415.