Newswise — Atrial fibrillation is a common complication of cardiac surgery, occurring in 10 percent to 40 percent of patients. Recent studies show it to be associated with poorer health following surgery and poorer long-term survival. Furthermore, development of atrial fibrillation after cardiac surgery leads to average additional health care costs of $15,000 to $20,000. As part of an ongoing NIH National Heart Lung and Blood Institute study, Giovanni Filardo, PhD, MPH, and his team are executing a large national multicenter study assessing the effectiveness of optimal preventive and management strategies (based on AHA/ACC/ESC and AACP guidelines) and their impact on incidence of post- coronary artery bypass graft surgery (CABG) atrial fibrillation and long-term survival. Dr. Filardo is Director of epidemiology, Baylor Health Care System’s Institute for Health Care Research and Improvement and The Bradley Family Endowed Chair in Cardiovascular Epidemiology, Baylor University Medical Center.

"Currently, we do not know what causes post-operative atrial fibrillation, nor how to identify patients at high risk and effectively prevent or mitigate this complication," explains Dr. Filardo. "These are the questions that the study seeks to answer."

Investigators will look at patients who underwent isolated coronary artery bypass graft surgery at Baylor University Medical Center (Dallas, TX) (BIUMC), THE HEART HOSPITAL Baylor Plano (Plano, TX) (THHBP), Emory University (Atlanta, GA), University of Virginia (Charlottesville, VA) or Washington University (St. Louis, MO). The study will provide insights into the prevention and management of post-operative atrial fibrillation, allowing health care providers to improve survival and decrease costs of care associated with coronary artery bypass graft surgery. The potential public health impact and cost savings are enormous: more than 100,000 people in the United States and 1.5 million people worldwide undergo isolated coronary artery bypass graft surgery each year. "Even taking the conservative estimate of 20 percent of those patients developing atrial fibrillation, the results of this study stand to improve survival for 300,000 people and save as much as $6 billion (300,000 people x $20,000 cost attributable to post-operative atrial fibrillation) in health care costs each year," said Dr. Filardo. Q: What is atrial fibrillation? Dr. Filardo: It is the most common cardiac arrhythmia (abnormal heart rhythm)Q: Who is affected by post operative atrial fibrillation?Dr. Filardo: Atrial fibrillation is a common complication of cardiac surgery; 20%-60% of patients undergoing cardiac surgery experience atrial fibrillation (AF). The problem is that AF significantly reduces survival (20% lower) and significantly increases post-operative costs. Recent studies show it to be associated with poorer health following surgery and poorer long-term survival. Development of atrial fibrillation after cardiac surgery leads to average additional health care costs of $15,000-$20,000.Q: What is the purpose of the study?Dr. Filardo: First, we want to identify the causes of new-onset AF in patients undergoing cardiac surgery. We also seek to discover if current guidelines for high risk patients are effective in preventing new-onset AF or if treatment protocols for those patients who do experience the condition are effective in improving survival.Q: When will the study begin and how long will it last?Dr. Filardo: It is a three-year study. The study started September 6, 2011 and will be completed on April 30, 2014.Q: What is the basic design of the study?Dr. Filardo: This is a retrospective study that will include 32,000 patients that underwent CABG at BUMC, THHBP, Emory, University of Virginia, and Washington University between January 1997 and December 2010. We designed a retrospective study so that we can have survival data available right away ...otherwise we needed to wait over 10 years to complete the study.Q: What does a NIH grant of this size mean for research at Baylor?Dr. Filardo: The Institute of Medicine (IOM) identified AF as a priority. We are leading the largest study in the country to assess new-onset AF causes and effectiveness of current optimal prophylaxis management in patients undergoing isolated CABG.Q: How will you use the data from the study?Dr. Filardo: When the study will be completed we will also have the largest (32,000 patients) new-onset post-CABG AF database. The data we will collect will significantly augment the Society of Thoracic Surgeons Adult Cardiac Database and can be used for future research.Q: What is the potential impact of this data?Dr. Filardo: Results will be applicable to more than 100,000 people in the United States and more than 1.5 million people worldwide annually. Besides mortality new-onset post-CABG atrial fibrillation also has a significant financial impact on costs. This is a study that can have a significant impact on mortality and costs. Results will support development of new and more effective strategies to prevent and manage the condition and will ultimately change current guidelines. With the aging of the overall United States population and the population undergoing CABG, post-CABG AF incidence is expected to increase – making rigorous research data about how best to reduce the burden of this common complication a public health priority.

About BRI: Established in 1984 in Dallas, Texas, Baylor Research Institute (BRI) promotes and supports research to bring innovative treatments from the laboratory workbench to the patient bedside. To achieve this bench-to-bedside concept, BRI focuses on basic science, clinical trials, health care effectiveness and quality of care research. Today, BRI is conducting more than 900 active research protocols with 350 research investigators, spanning more than 20 medical specialties, and has research and development projects in areas ranging from human immunology and orphan metabolic diseases to diabetes, cardiovascular disease and many other unmet medical needs. Its precision medicine arm offers a unique platform for identifying micro-array-based fingerprint signatures. The Baylor Health Care System offers to its research affiliate unique access to one of the largest patient bases potentially available for research in the US within a single institution. BRI has received full accreditation from AAHRPP. www.baylorhealth.edu/research/* grant number R01HL103683** grant number R01HS018576