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Rove et al. Vessel Plus 2022;6:55 Vessel Plus
DOI: 10.20517/2574-1209.2021.133

Perspective Open Access

Taking on the elephant in the room-postoperative

atrial fibrillation: a clinical program management
perspective

4
3
1,2
Jessica Y. Rove , Wendy S. Tzou , A. Laurie Shroyer , Frederick L. Grover 1,2
1
Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado, Aurora, CO 80045, USA.
2
Rocky Mountain Regional Veterans Affairs Medical Center, Section of Cardiothoracic Surgery, Aurora, CO 80045, USA.
3
Division of Cardiology, University of Colorado, Department of Medicine, Aurora, CO 80045, USA.
4
Northport Veterans Affairs Medical Center, Northport, NY 11768, USA.
Correspondence to: Jessica Y. Rove, Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado, Aurora,
CO 80045, USA. E-mail: Jessica.rove@cuanschutz.edu
How to cite this article: Rove JY, Tzou WS, Shroyer AL, Grover FL. Taking on the elephant in the room-postoperative atrial
fibrillation: a clinical program management perspective. Vessel Plus 2022;6:55. https://dx.doi.org/10.20517/2574-1209.2021.133
Received: 8 Nov 2021 First Decision: 10 Feb 2022 Revised: 25 Mar 2022 Accepted: 1 Apr 2022 Published: 10 Oct 2022

Academic Editor: Frank W. Sellke Copy Editor: Tiantian Shi Production Editor: Tiantian Shi

Abstract
Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery, yet there is no
consistent cardiothoracic professional society-based definition of new-onset POAF, nor a broadly accepted
consensus on how to prevent or treat it. Importantly, there is an ever-growing body of evidence that new-onset
POAF is associated with worse patient outcomes. Given the lack of evidence-based guidelines, detection and
treatment of POAF, in addition to understanding how POAF is related to these worse outcomes, represents an
unaddressed quality of care concern. In the United States, the annual cardiac surgical POAF patient costs are
estimated at ~$1 billion. The entire US Medicare annual budget has been reported at ~$141.2 billion for all hospital-
related care; thus, the administrative challenges uniquely posed by POAF have been exposed for the first time.
Mapping future tactics, this Vessel Plus special atrial fibrillation publication, swings the pendulum from impromptu
observations towards action. A new strategic framework is proposed to begin the tedious but necessary task of
taking on this elephant in the room. With ideal collaboration between clinical providers, health care systems,
professional societies and insurers, a five-step approach is proposed to overcome these POAF patient care
challenges.

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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