Lessening the Incidence of Postoperative Atrial Fibrillation
The issue of reducing or preventing atrial fibrillation (AF) after cardiac surgery has been the subject of numerous studies. Existing studies sought to establish which agents are effective in this process since multiple agents are used to prevent AF. Reduction of incidence of postoperative atrial fibrillation is critical in order to promote the outcomes of patients undergoing cardiac surgery. In addition to flutter, atrial fibrillation is usually observed in the immediate aftermath of cardiac surgery. While clinical studies have shown that medications have positive impacts in preventing atrial fibrillation, they can be cause of these kinds of arrhythmias. Therefore, clinicians are faced with the need to identify suitable interventions for lessening the incidence of postoperative atrial fibrillation in the aftermath of cardiac surgery, which is the subject of this research.

Clinical Question and Importance to Nursing

The incidence rates of postoperative arrhythmias such as flutter and atrial fibrillation in the first days after cardiac surgery is estimated to be between 17% and 33% and differs based on the method used for its identification and the criteria for definition (Lucio et al., 2004). Given these statistics, atrial fibrillation is regarded as one of the most common types of postoperative arrhythmias among patients undergoing cardiac surgery. This condition can also coexist with other forms of arrhythmias like atrial flutter. While the incidence rates of atrial fibrillation continues to increase among these patients, its etiology remains relatively unknown. As a result, current clinical practice relies on stimuli like pericarditis, intraoperative atrial ischemia, and extreme adrenergic stimulation for detection. In this regard, the stimuli play a critical role in the appearance of atrial fibrillation among vulnerable patients undergoing cardiac surgery.

Despite the recognition of the high incidence rates of atrial fibrillation among cardiac surgery patients, the modern healthcare environment struggles to identify a suitable intervention for lessening these incidence rates. As a result, multiple agents including amiodarone and metoprolol have been used to help prevent AF after cardiac surgery. While these agents have shown promising results, clinicians face the need to establish their effectiveness in lessening postoperative AF incidence rates. To this extent, this study seeks to establish the effectiveness of one of these agents i.e. metoprolol in achieving this. The research will be guided by the following PICO question…

Does taking Metoprolol before cardiac surgery reduce the incidence of postoperative atrial fibrillation?

Examining this issue is critical to nursing because the increasing incidence rates of postoperative AF among patients undergoing cardiac surgery continues to pose significant threats to enhanced patient outcomes and safety in cardiac care settings. Valtola et al. (2007) states that the rates of postoperative atrial fibrillation remains significantly high while the effectiveness of beta-blockers like metoprolol in reducing these rates efficiently remains unknown. Therefore, this study will help address existing gaps in literature regarding the role and significance of beta-blockers such as metoprolol in lessening the incidence of postoperative atrial fibrillation in an efficient manner. Through addressing the existing gap in literature, the study will contribute toward enhanced clinical practice with regards to provide evidence-based care to patients undergoing cardiac surgery while enhancing their outcomes and safety.

Literature Search

To achieve the purpose of the study, a search of existing literature on the topic was carried out. The literature search helped to identify studies on this issue and their key findings that could be utilized to promote changes in clinical practice...…reasonable level or extent of implementing the use of metoprolol prior to cardiac surgery. Existing studies do not provide insights on the reasonable time period with which a patient should take metoprolol prior to undergoing cardiac surgery. Even though existing literature establishes the need to use metoprolol during preoperative and perioperative periods, there is dearth of information on the exact time periods for use of this drug prior to cardiac surgery. Secondly, existing literature does not examine the role individual factors play in determining the effectiveness of metoprolol in lessening the incidence of postoperative atrial fibrillation. This is a critical factor given the differences in body responses to different drugs, which implies that individual factors could play a role in the effectiveness of these drugs.

Therefore, future studies should be conducted to examine whether the length of time between taking metoprolol and undergoing cardiac surgery affects its ability to lessen incidence of postoperative AF. This would help ensure the drugs are administered at an appropriate time before surgery. Secondly, the role of individual factors in determining the effectiveness of metoprolol should be examined. This would help to establish suitable conditions that would enhance the drug’s effectiveness prior to administration.

Discussion

Literature findings demonstrate that clinical practice in cardiac care setting should entail the administration of metoprolol prior to cardiac surgery. Clinicians should increase their use of this drug in the clinical setting in comparison to other processes/measures targeting reduction of incidence of postoperative atrial fibrillation. During this process, clinicians should ensure that the drugs are administered intravenously rather than orally. These suggested changes or improvements in nursing practice would help enhance the reduction of postoperative atrial fibrillation rates among patients undergoing cardiac surgery.