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Page 2 of 20 Pardo et al. Vessel Plus 2022;6:36 https://dx.doi.org/10.20517/2574-1209.2021.120

Conclusion: Across ten professional societies, 50% had no POAF definition; of the remaining five, no POAF
definitional consistency was found. Across the eight US-based professional society POAF-related guidelines, only
anticoagulation was uniformly recommended. Given these “big picture” findings, professional societies are urged to
work collaboratively to harmonize these divergent POAF definitions and consolidate their evidence-based guideline
recommendations to improve future POAF patients’ quality of care.

Keywords: Postoperative atrial fibrillation, cardiac surgery, professional society, guidelines management, guidelines
management, clinical management

INTRODUCTION
Post-operative atrial fibrillation (POAF) occurs in 20%-50% of cardiac operations and 10%-30% of non-
[1,2]
cardiac surgeries . Despite this high POAF rate, there is an astonishing lack of consensus among
professional societies on an official POAF definition and POAF patients’ management.

Over the last decade, POAF has garnered increased attention; POAF is associated with increased hospital
length of stay and costs . In spite of this POAF spotlight, persistent disparities exist as to how hospitals and
[3]
clinicians identify, monitor, and manage patients with a POAF complication.

Brief history
In 1966, Dr. Avedis Donabedian published his landmark quality improvement framework, which is
commonly used today to evaluate healthcare quality . In 1992, the Department of Veterans Affairs (VA)
[4]
health care system was the first health care organization to define and monitor surgical patients’
[5]
preoperative and postoperative atrial fibrillation . Based on these historical VA endeavors, the STS in 2000
published their first POAF definition (i.e., adult cardiac surgery database, version 2.35), which has become
the “gold standard” definition [4,6,7] . Since then, there have been many publications evaluating POAF’s impact
on surgical patients’ clinical outcomes and resource utilization. Despite the initial VA and STS POAF
definitional uniformity, there has been a growing divergence across the POAF definitions used by surgical
society databases as well as the subsequent guidelines promulgated. Comparing the cardiothoracic versus
non-cardiothoracic surgical society-based publications, this study documents the tremendous diversity of
POAF definitions for the first time.

METHODS
For this qualitative content analysis, ten professional societies’ cardiac interventional database definitions
and clinical guideline recommendations were analyzed. Societies were classified into procedural versus
medical, based upon their specialization as listed below.

Cardiothoracic Interventional Societies (CT societies)

1. Society of Thoracic Surgeons (STS) [6]

2. American Association for Thoracic Surgery (AATS) [8]

3. Society for Cardiovascular Angiography and Interventions (SCAI) [9]