Quality and Outcomes

Management of Postoperative Atrial

Fibrillation and Subsequent Outcomes in
Contemporary Patients Undergoing Cardiac
Surgery: Insights From the Society of
Thoracic Surgeons CAPS-Care Atrial
Fibrillation Registry

Address for correspondence:

Benjamin A. Steinberg, MD
Electrophysiology Section,
Duke Clinical Research Institute
Duke University Medical Center
PO Box 17969
Durham, NC 27715
benjamin.steinberg@duke.edu

Benjamin A. Steinberg, MD; Yue Zhao, PhD; Xia He, MS; Adrian F. Hernandez, MD;
David A. Fullerton, MD; Kevin L. Thomas, MD; Roger Mills, MD; Winslow Klaskala, PhD;
Eric D. Peterson, MD, MPH; Jonathan P. Piccini, MD, MHS
Department of Medicine (Steinberg, Hernandez, Thomas, Peterson, Piccini), Duke University
Medical Center, Durham, North Carolina ; Duke Clinical Research Institute (Steinberg, Zhao, He,
Hernandez, Thomas, Peterson, Piccini), Durham, North Carolina; Department of Surgery
(Fullerton), University of Colorado, Denver, Colorado; Janssen Research & Development LLC
(Mills, Klaskala), Raritan, New Jersey

Background: Postoperative atrial brillation (POAF) is a well-recognized complication of cardiac surgery;

however, its management remains a challenge, and the implementation and outcomes of various strategies in
clinical practice remain unclear.
Hypothesis: We hypothesize that treatment for POAF is variable, and that it is associated with particular
morbidity and mortality following cardiac surgery.
Methods: We compared patient characteristics, operative procedures, postoperative management, and
outcomes between patients with and without POAF following coronary artery bypass grafting (CABG) in
the Society of Thoracic Surgeons multicenter Contemporary Analysis of Perioperative Cardiovascular Surgical
Care (CAPS-Care) registry (2004 2005).
Results: Of 2390 patients who underwent CABG, 676 (28%) had POAF. Compared with patients without POAF,
those with POAF were older (median age 74 vs 71 years, P < 0.0001) and more likely to have hypertension
(86% vs 83%, P = 0.04) and impaired renal function (median estimated glomerular ltration rate 56.9 vs 58.6
mL/min/1.73 m2 , P = 0.0001). A majority of patients with POAF were treated with amiodarone (77%) and
-blockers (68%); few (9.9%) underwent cardioversion. Patients with POAF were more likely to experience
complications (57% vs 41%, P < 0.0001), including acute limb ischemia (1.0% vs 0.4%, P = 0.03), stroke (4.0%
vs 1.9%, P = 0.002), and reoperation (13% vs 7.9%, P < 0.0001). Length of stay (median 8 days vs 6 days, P <
0.0001), in-hospital mortality (6.8% vs 3.7%, P = 0.001), and 30-day mortality (7.8 vs 3.9, P < 0.0001) were all
worse for patients with POAF. In adjusted analyses, POAF remained associated with increased length of stay
following surgery (adjusted ratio of the mean: 1.27, 95% condence interval: 1.2-1.34, P < 0.0001).
Conclusions: Postoperative AF is common following CABG, and such patients continue to have higher rates
of postoperative complications. Postoperative AF is signicantly associated with increased length of stay
following surgery.

This analysis was funded by a grant from Janssen Scientific Affairs LLC, Raritan NJ. The study design, analysis plan,
statistical analysis, and drafting of the manuscript were performed independently of the funding entity. Each author takes
responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed
interpretation. Dr. Steinberg was funded by National Institutes of Health T-32 training grant No. 5 T32 HL 7101-37. The
following relationships exist related to this article: Dr. Steinberg received minor educational support from Medtronic;
Dr. Zhao and Mr. He have no disclosures; Dr. Piccini receives research funding from Johnson & Johnson and provides
consulting to Forest Laboratories, Janssen Pharmaceuticals, and Medtronic. Dr. Mills and Dr. Klaskala are full-time
employees of Janssen Research & Development, LLC; a detailed description of Dr. Piccinis, Dr. Hernandezs, and Dr.
Petersons disclosures can be found at https://dcri.org/about-us/conflict-of-interest.
The authors have no other funding, financial relationships, or conflicts of interest to
disclose.
Additional Supporting Information may be found in the online version of this
article.
Received: September 11, 2013
Accepted with revision: October 31, 2013

Clin. Cardiol. 37, 1, 7 13 (2014)

Published online in Wiley Online Library (wileyonlinelibrary.com)
DOI:10.1002/clc.22230 2013 Wiley Periodicals, Inc.

Introduction
Atrial fibrillation (AF) is the most common sustained
cardiac arrhythmia in clinical practice and frequently
complicates cardiac surgery.1 Several studies have
attempted to identify predictors of postoperative AF
(POAF), with advanced age persisting as the most
potent and consistent risk factor, followed by a
history of AF, chronic obstructive pulmonary
disease, and several operative characteristics.1 3
Previous
studies have linked POAF to increased mortality
following surgery.4
Several trials have studied interventions for
prevention
of POAF, including atrial pacing, -blockers, sotalol,
and amiodarone.5 However, there are few data
regarding
the efficacy of rhythm control and
thromboembolic prophylaxis strategies once POAF
has occurred. It
is also not clear whether
preventive strategies are widely employed in
clinical practice. Lastly, the impact of POAF on
clinical outcomes and health care utilization in
contemporary cohorts remains unknown, as
operative outcomes have
improved overall.6 8 We undertook the present
study to
assess clinical management and outcomes of patients
with POAF following coronary artery bypass grafting
(CABG) surgery in routine clinical practice settings.
Methods
The present study utilized
data from the
Contemporary
Analysis
of
Perioperative
Cardiovascular Surgical Care (CAPS-Care) registry, a
substudy of the Society of Thoracic Surgeons (STS)
database. The details of CAPS-Care have been
described previously.9,10 Briefly, the CAPS-Care initiative was an observational prospective cohort study
designed
to
examine
the
utilization
of
pharmacotherapies and other interventions in
patients undergoing
cardiac surgery. The STS
National Adult Cardiac Surgery Database served as
the primary dataset and included demographics,
medical history, operative characteristics,
and
additional data on hospital course, including
procedures, in-hospital outcomes, and discharge
disposition, as well as discharge medica- tions,
30-day rehospitalization, and mortality.11
Further
details on STS data collected are available
at
http://www. sts.org/sts-national-database/databasemanagers/adult-car
diac-surgery-database/datacollection. These data were augmented by chart
review using the CAPS-Care case- report form,
emphasizing
perioperative
pharmacotherapies
(including vasoactive drugs). The CAPS-Care data
were ascertained from 55 STS sites from May
11, 2006, to December 31, 2006. The study cohort
was limited to those undergoing CABG (with or
without concomitant valve or AF surgery) between
2004 and 2005.
The patients were stratified by incidence of
POAF, captured on the case-report form and

Clin. Cardiol. 37, 1, 7 13 (2014)

B. Steinberg et al: Treatment and outcomes of postoperative AF
Published online in Wiley Online Library (wileyonlinelibrary.com)
DOI:10.1002/clc.22230 2013 Wiley Periodicals, Inc.

defined as any sustained AF that occurred in the

postoperative
period while hospitalized. Atrial
fibrillation occurring after hospital discharge was not
captured. In-hospital, postoperative medication use,
complications, and clinical outcomes were compared
between groups with and without POAF.
Statistical Analysis
Continuous variables are displayed as medians
(interquar- tile ranges), with categorical variables
displayed as percent- ages. For categorical variables,
P values were calculated

using Pearson 2 tests, whereas Wilcoxon rank-based

group means were used for all continuous or ordinal
variables. All P values were calculated by comparing
nonmissing data. P val- ues < 0.05 were considered
significant. Readmission within
30 days was defined from the date of surgery. Patients
who died or who had length of stay >10 days (or
whose length of stay was missing) were excluded
from analyses of readmis- sion rates within 30 days of
surgery to minimize the impact of outliers and
survival bias. Multivariate analyses for the outcome
of length of stay (a continuous variable) were modeled using a negative binomial regression model.
Robust sandwich variance estimates were used to
obtain 95% confi- dence intervals (CI) to account for
statistical dependence of patients within sites.
Subsequently, a parsimonious model was selected
from the full list of candidate variables using a
backward algorithm with a significance criterion of P =
0.05. All statistical analyses of the aggregate, deidentified data were performed by the Duke Clinical
Research Institute using SAS software version 9.2
(SAS Institute Inc., Cary, NC). All of the authors had
full access to the data and take
responsibility for the validity
herein.
Results
Among 2390 patients enrolled in CAPS-Care during
the study period, 676 (28%) experienced POAF
following CABG, whereas 1714 were free of POAF
in the postoperative period. Those with POAF were
older (median age 74 vs
71 years, P < 0.0001) and more likely to have
hypertension (86% vs
83%,
P = 0.04) and
impaired
renal
function (median estimated
glomerular filtration rate 56.9 vs 58.6 mL/min/1.73
m2 ,
P = 0.0001) but had lower rates of
hypercholesterolemia (72% vs 77%, P = 0.02) and
tobacco use (12% vs 20%, P < 0.0001; Table 1).
Patients in the POAF group had higher average left
ventricular ejection fraction (median 48% vs 40%, P
= 0.002) and were at greater
risk for
thromboembolic events as assessed by CHADS2
scores (81% with CHADS2 2 vs 75% for no POAF, P =
0.001).
Patients with POAF were less likely to have
undergone an isolated CABG procedure (72% vs
76%, P = 0.001) and more likely to have concomitant
valve or AF intervention. Significantly more patients in
the POAF group underwent aortic-valve replacement
(16% vs 9.9%, P < 0.0001), and median perfusion
and cross-clamp times (for both on- pump and
off-pump procedures) were all longer in the POAF
group (Table 2). More than three-quarters of patients
with POAF received amiodarone postoperatively, and
more than two-thirds received -blockers (Figure 1).
Less than one-third of patients received calcium
channel blockers or other antiarrhythmic agents.
Slightly <10% underwent direct-current cardioversion.
Patients with POAF were more likely to suffer
compli-

cations (57% vs 41%, P < 0.0001), including

reoperation for any reason (13% vs 7.9%, P <
0.0001), neurological events such as stroke or
transient ischemic attack (6.7% vs 2.9%, P < 0.0001),
renal failure (13% vs 5.6%, P < 0.0001), acute limb
ischemia (1.0% vs 0.4%, P = 0.03), or a ventricular
arrhythmia requiring intervention (7% vs 3.4%, P =
0.0001; Table 3). Among patients with POAF, there was
a nonsignif- icant trend toward higher rates of stroke
in patients with higher CHADS2 score (3.2% vs 4.2%, P
= 0.6; Figure 2).

Clin. Cardiol. 37, 1, 7 13

(2014) B. Steinberg et al: Treatment and outcomes of
postoperative AF Published online in Wiley Online Library
(wileyonlinelibrary.com) DOI:10.1002/clc.22230 2013 Wiley
Periodicals, Inc.

Table 1. Baseline Characteristics

Age, y
Female

Table 1. continued
No POAF,
n = 1714
Value
71 (66 76)
33

POAF,
n = 676

74 (69 79) < 0.0001

34

Race

POAF,
n = 676

P Value

1.1 (1.0 1.4)

1.2 (1.0 1.5)

0.01

0.9

eGFR, mL/min/1.73 m

59 (49 78)

57 (46 75)

0.0001

0.2

LVEF

40 (30 55)

48 (35 60)

0.002

Caucasian

88

91

Preoperative ECG

Black

4.3

2.5

Sinus

82

89

Hispanic

2.2

1.8

AF or atrial utter

9.5

3.3

Asian

0.9

1.3

Paced

3.5

2.4

Native American

0.6

0.2

Other

4.6

5.5

Other

3.0

3.0

<0.0001

Preoperative CHADS2 score

Medical history

0.001

4.7

2.4

Hypertension

83

86

0.04

20

16

DM

53

53

0.8

>=2

75

81

Hypercholesterolemia

77

72

0.02

Current use of any tobacco

20

12

< 0.0001

CVD

21

24

0.08

Stroke

14

18

0.06

PVD

19

22

0.2

Chronic lung disease

(moderate or severe)

15

12

0.1

Preoperative dialysis

2.0

3.6

0.03

Prior CABG or PCI

23

21

0.2

Prior valve surgery

1.1

1.2

0.8

-Blocker

69

69

0.9

ACE inhibitor

46

44

0.5

Statin

36

38

0.9

Preoperative medical therapy

Anticoagulant

0.7

Heparin (unfractionated)

43

43

LMWH

14

17

Direct thrombin inhibitor

0.7

0.9

Warfarin

1.9

1.8

0.8

Preoperative clinical data

BMI, kg/m2

28 (25 32)

28 (25 32)

0.6

Heart rate, bpm

70 (60 80)

68 (60 78)

0.01

SBP, mm Hg
DBP, mm Hg
Hemoglobin, mg/dL

10

Serum Cr, mg/dL

No POAF,
n = 1714

130 (111 146) 129 (112 145)

62 (56 72)

60 (55 71)

0.8
0.1

13 (11.6 14.2) 12.8 (11.4 14.1) 0.06

Clin. Cardiol. 37, 1, 7 13 (2014)

B. Steinberg et al: Treatment and outcomes of postoperative AF
Published online in Wiley Online Library (wileyonlinelibrary.com)
DOI:10.1002/clc.22230 2013 Wiley Periodicals, Inc.

Abbreviations: ACE, angiotensin-converting enzyme; AF, atrial brillation; BMI, body mass index; CABG, coronary artery bypass grafting;
CHADS2 , congestive heart failure, hypertension, age 75 years,
diabetes mellitus, prior stroke/transient ischemic attack or
thromboembolism; Cr, creatinine; CVD, cerebrovascular disease; DBP,
diastolic blood pres- sure; DM, diabetes mellitus; ECG,
electrocardiogram; eGFR, estimated glomerular ltration rate; IQR,
interquartile range; LMWH, low molecular weight heparin; LVEF, left
ventricular ejection fraction; PCI, percuta- neous coronary
intervention; POAF, postoperative atrial brillation; PVD, peripheral
vascular disease; SBP, systolic blood pressure. Baseline
characteristics, comorbidities, admission data, and laboratory studies
are stratied by POAF. Values are presented as % or median (IQR).

Overall, patients with POAF had a significantly

longer median length of stay (8 days vs 6 days,
P < 0.0001) and higher in-hospital (6.8% vs 3.7%, P
= 0.001) and 30- day (7.8% vs 3.9%, P < 0.0001)
mortality when compared with those without POAF.
The effect on length of stay persisted in
multivariate analysis: POAF remained a strong and
independent predictor of increased length of stay in
patients undergoing CABG (adjusted ratio of the
mean:
1.27, 95% CI: 1.2-1.34, P < 0.0001, z statistic: 8.6).
In the overall study population of 2390 patients,
500 were excluded from analysis of readmission
due to death (n = 109), length of stay >10 days
(n = 381), or missing length of stay (n = 10). Of the
remaining 1890, 445 (24%) had POAF. Patients with
and without POAF in this population mirrored those
of the overall study those with POAF were older
with a similar distribution of comorbidities (see
Supporting Information, Appendix Tables 1 5, in the
online version of this article). Patients with POAF in
this subset were readmitted at numerically greater
rate, although the difference was not statistically
significant (12% vs 9.9%, P = 0.2). The reasons for
readmission were similar in those with and without
POAF (Table 4).
A sensitivity analysis was conducted excluding
patients with preoperative
AF (n = 184/2390,

Table 1. Baseline Characteristics

Table 1. continued

7.7%). The results were consistent with the overall

analysis (see Supporting Information, Appendix Tables
1 5, in the online version of

Clin. Cardiol. 37, 1, 7 13

(2014) B. Steinberg et al: Treatment and outcomes of
postoperative AF Published online in Wiley Online Library
(wileyonlinelibrary.com) DOI:10.1002/clc.22230 2013 Wiley
Periodicals, Inc.

11

protective effect of preop- erative use of HMG-CoA

reductase inhibitors (statins)14,15 ;

Table 2. Operative Characteristics

No POAF,
n = 1714

POAF,
n = 676

Status of surgery

0.7

Elective

51

52

Urgent

49

48

Procedure groups

0.001

Isolated CABG

76

72

CABG and valve intervention

(no AF correction)

16

22

CABG and AF correction

3.0

1.8

CABG and other

5.4

4.3

Cardiopulmonary bypass

0.7

None

11

10

Combination

0.6

0.9

Full

47

49

Off-pump

9.9

9.9

Perfusion time, min (all)

Perfusion time, min (if on
0.01 pump)
Cross-clamp time, min (all)
Cross-clamp time, min (if on
0.003 pump)

P Value

108 (83 143) 115 (88 148)

1.0
0.002

107 (85 141) 116 (89 148)

74 (54 105)

81 (59 112)

71 (53 100)

80 (58 111)

0.004

Abbreviations: AF, atrial brillation; CABG, coronary artery bypass

grafting; IQR, interquartile range; POAF, postoperative atrial brillation.
Operative characteristics of all included patients, stratied by
occurrence of POAF. Values are presented as % or median (IQR).

this article). Rates of complications were significantly

higher in patients with POAF, and POAF remained a
significant, multivariate predictor of increased length
of stay (adjusted ratio of the mean: 1.29, 95% CI: 1.221.36, P < 0.0001).
Discussion
Postoperative AF complicated 28% of surgeries
in
a contemporary cohort of 2390 patients
undergoing high-risk CABG. Patients with POAF were
older and more likely to have renal dysfunction, yet
they had higher median ejection fractions and were
less likely to have hypercholesterolemia. The majority
of patients with POAF were treated with amiodarone
and -blockers.
Only 1 in 10 patients with POAF
underwent
cardioversion.
Patients
with
POAF
experienced a 50%
higher complication rate
postoperatively, and the occurrence of POAF was
highly associated with increased length of stay in
both unadjusted and adjusted analyses.
Increased age has been associated with POAF in
several prior studies,2,12,13 yet hypercholesterolemia,
as a negative association, represented a paradox in
our data. Previous research demonstrated a potential

12

Clin. Cardiol. 37, 1, 7 13 (2014)

B. Steinberg et al: Treatment and outcomes of postoperative AF
Published online in Wiley Online Library (wileyonlinelibrary.com)
DOI:10.1002/clc.22230 2013 Wiley Periodicals, Inc.

hospital prior to discharge; however, the benefit

of predischarge conversion is unclear. Overall data
in the general AF population are equivocal on the
value of rhythm control,22 and similar data on
cardioversion for POAF are limited.19

Figure 1. Management of patients with POAF following coronary artery

bypass grafting surgery. Abbreviations: AF, atrial brillation; POAF,
postoperative atrial brillation.

however, we observed similar use of statins

immediately prior to surgery. Thus, although we
cannot exclude a difference in long-term prior statin
exposure between the groups, we did not observe a
protective effect. Nevertheless, statin use as
prophylaxis for POAF continues to be a subject of
interest, with a recent meta-analysis demonstrating
a reduction in POAF as high as 60%.16 The same
study also observed a concomitant reduction in
intensive care unit and overall hospital length of stay,
suggesting POAF may be a major contributor to such
outcomes.
Previous studies have described higher mortality
asso- ciated with POAF,4,17 yet few have described
the details of postoperative complications in a
contemporary cohort. Patients with POAF in our
cohort were more likely to have myriad other
postoperative problems, including reopera- tion,
neurological events, infections, and multisystem organ
failure. Despite potential confounders,
POAF
persisted in multivariate analysis as a significant
predictor of increased length of stay, which likely
drives the increased cost of care associated with
POAF.18 Additional predictors of length of stay in this
study may represent events causally associated with
POAF (eg, the development of heart failure, neurologic
events, and peripheral vascular complications), and
pre- liminary data suggest that more aggressive
rhythm control may improve length of stay.19 With
intensive care unit costs rising to several thousand
dollars per day, reducing length of stay could save
millions of dollars annually.
Management strategies for POAF in this study
were consistent with general clinical practice, where
physicians commonly opt to treat POAF medically in
the near term with high rates of reversion to sinus
rhythm.19 Amiodarone and -blockers were the
most common pharmacologic interventions in our
POAF cohort, consistent
with prior trials
demonstrating their utility in both preventing and
treating POAF.5,20,21 In the current study, roughly 1 in
10 patients with POAF underwent cardioversion in the

Clin. Cardiol. 37, 1, 7 13

(2014) B. Steinberg et al: Treatment and outcomes of
postoperative AF Published online in Wiley Online Library
(wileyonlinelibrary.com) DOI:10.1002/clc.22230 2013 Wiley
Periodicals, Inc.

13

Table 3. Unadjusted Outcomes, Stratied by POAF

No POAF,
n = 1714
Value
41

POAF,
n = 676
57

< 0.0001

All-cause reoperation

7.9

13

< 0.0001

Any neurological event

2.9

6.7

< 0.0001

Stroke >24 hours

1.9

4.0

0.002

TIA

0.8

2.1

0.005

TIA or stroke >24 hours

2.5

6.1

< 0.0001

Radiographic evidence of HF

30

41

< 0.0001

Vascular and other events

(excluding AF)

11

21

< 0.0001

Anticoagulant complication

0.9

1.8

0.09

Renal failure

5.6

13

< 0.0001

Dialysis

1.9

5.6

< 0.0001

Acute limb ischemia

0.4

1.0

0.03

Heart block

2.5

3.0

0.5

VT/VF requiring intervention

3.4

7.0

0.0001

Cardiac arrest

2.7

4.1

0.07

GI complication

2.8

6.7

< 0.0001

Any infection

2.2

5.3

< 0.0001

Prolonged ventilation

12

20

< 0.0001

Multisystem failure

1.0

3.1

0.0002

Other complications

3.5

7.8

< 0.0001

Any complication

Postoperative length of stay, d

>14 days

6 (5 8)

8 (6 12)

< 0.0001

6.8

18

< 0.0001

Readmission within 30 days of

surgerya

9.9

12

0.3

In-hospital mortality (any

timeframe)

3.7

6.8

0.001

30-day mortality

3.9

7.8

< 0.0001

Abbreviations: AF, atrial brillation; GI, gastrointestinal; HF, heart

failure; IQR, interquartile range; POAF, postoperative atrial
brillation; TIA, transient ischemic attack; VT/VF,
ventricular
tachycardia/ventricular brillation.
Unadjusted rates of postoperative outcomes, stratied by POAF. Values
are presented as % or median (IQR).
a
Readmission rates exclude patients who died or who had
postoperative
length of stay >10 days or missing (see Table 4).

For patients with POAF, numerically lower

readmission rates were observed in those
discharged on warfarin. It is striking that a significant
percentage of patients with POAF in this study were
not discharged on anticoagulation (173 of
445). Guidelines cite POAF as a reversible cause,23

Figure 2. Unadjusted outcomes of stroke and 30-day mortality in patients

with and without POAF, and stratied by CHADS2 score in those with
POAF. Abbreviations: CHADS2 , congestive heart failure, hypertension, age
75 years, diabetes mellitus, prior stroke/transient ischemic attack or
thromboembolism; POAF, postoperative atrial brillation.

in those who remain in AF at discharge.24 Although

data from large randomized trials of thromboembolic
prophylaxis in POAF are lacking, patients with POAF
in the current study had higher CHADS2 scores and
significantly higher rates of stroke or transient
ischemic attack early after surgery, when
compared with those who did not have POAF. In
view of prior observations that POAF portends a
significantly higher risk of late AF (>5 years) and
stroke,4 our observational data warrant testing of the
hypothesis that patients with any occurrence of POAF
may benefit from both early and long-term
anticoagulation for thromboembolic prophylaxis.
Study Limitations
The present study represents data from a
retrospective, observational cohort and thus carries
the limitations inher- ent to such methods. These
may include biases related to the selection,
enrollment, and/or reporting of such patients. Other
studies have noted a significant incidence of postdischarge AF early after cardiac surgery,25 which
was not captured in the present study. Additionally,
postoperative medical therapy cannot be specifically
attributed to POAF, vs other indications (eg, -blockers
for CAD vs POAF). Lastly, the observed relationship
between POAF and outcome is an association, and
we cannot, based on these analyses, infer a causal
relationship between POAF and outcome.
which has led to the common practice of either
limited,
temporary,
or
no
thromboembolic
prophylaxis in these patients, even

Clin. Cardiol. 37, 1, 7 13

(2014) B. Steinberg et al: Treatment and outcomes of
postoperative AF Published online in Wiley Online Library
(wileyonlinelibrary.com) DOI:10.1002/clc.22230 2013 Wiley
Periodicals, Inc.

11

Table 3. Unadjusted Outcomes, Stratied by POAF

Conclusions
Postoperative AF is a common complication for
contempo- rary patients undergoing CABG, and the
majority of patients are medically managed with
amiodarone and/or -blockers. When compared
with patients without POAF, those with POAF also
have consistently and significantly higher rates of all
types of complications. After multivariable adjustment, POAF remains a significant predictor
of
increased length of stay following CABG. Further
investigations of strategies for the prevention and
management of POAF are warranted.

12

Clin. Cardiol. 37, 1, 7 13 (2014)

B. Steinberg et al: Treatment and outcomes of postoperative AF
Published online in Wiley Online Library (wileyonlinelibrary.com)
DOI:10.1002/clc.22230 2013 Wiley Periodicals, Inc.

Acknowledgments
The authors dedicate this article to the memory of our
good friend and colleague, Winslow Klaskala, PhD.

Table 4. Readmission Rates by POAF

No POAF
POAF
Readmission
Before
Before
Rate,
Discharge, Discharge,
N = 1890
n = 1445
n = 445
Overall readmission
rates within 30 d of
surgery
Reason for
0.8 readmission

10

n = 196

9.9

n = 143

12

P Value
0.2

References
1.

n = 53
2.

Arrhythmia or heart
block

10

9.8

11

CHF

17

17

15

MI and/or recurrent
angina

4.6

5.6

1.9

Pericardial effusion
and/or tamponade

4.1

3.5

5.7

Pneumonia or other
respiratory
complication

12

12

13

Any infection

12

11

13

Renal failure

1.0

1.4

TIA

1.0

0.7

1.9

Permanent CVA

1.5

2.1

Acute vascular
complication

3.1

2.8

3.8

Anticoagulation
complication

0.5

0.7

Other complication

11

13

7.6

Other, related
readmission

12

13

9.4

Other, nonrelated
readmission

7.7

6.3

11

3.

4.

5.

6.

7.

8.
9.

10.

11.

Readmission by
anticoagulation
status

0.08
12.

Discharged on
warfarin, n = 207

15

17 (22/128) 11.4 (9/79)

Not discharged on
warfarin, n = 876

10

9.7 (68/703) 13 (22/173)

Warfarin data
missing, n = 807

9.3

13.

14.
8.6 (53/614) 11 (22/193)

Abbreviations: AF, atrial brillation; CHF, congestive heart failure; CVA, cerebrovascular accident; MI, myocardial infarction;
POAF, postoperative atrial brillation; TIA, transient ischemic
attack.
Readmission rates by reason, stratied by POAF and use of
anticoagulation at discharge. Rates exclude patients who died or who
had postoperative length of stay >10 days or missing. Values are
presented as column % for overall rates, and as % of subgroups for
readmission reason and anticoagulation.

15.
16.

17.

18.

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Clin. Cardiol. 37, 1, 7 13

(2014) B. Steinberg et al: Treatment and outcomes of
postoperative AF Published online in Wiley Online Library
(wileyonlinelibrary.com) DOI:10.1002/clc.22230 2013 Wiley
Periodicals, Inc.

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