Current status of medical staff implementing the guidelines for atrial fibrillation after coronary artery bypass grafting: A multicenter cross-sectional study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUO Lin ¹ , LIU Youhua ² , WANG Xinyu ¹ , LIU Guixin ¹ , TALXEN Yesbol ¹ ,  LIU Yisi ¹

1. School of Nursing, Capital Medical University, Beijing, 100069, P. R. China;
2. Department of Cardiovascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P. R. China;

Corresponding author：

LIU Yisi, Email: asceticsisi@aliyun.com

Keywords：

Postoperative atrial fibrillation; coronary artery bypass grafting; guideline adherence; knowledge-attitude-belief-practice; investigation

DOI：

10.7507/1007-4848.202306001

Video：

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Objective To investigate the mastery of the management knowledge of patients with atrial fibrillation after coronary artery bypass grafting by cardiac surgeons in Beijing tertiary hospitals, and the practice status and obstacles of following the guidelines for postoperative atrial fibrillation. Methods A convenient sampling method was used to select cardiac surgeons from four tertiary hospitals in Beijing, and a self-designed questionnaire on the management of postoperative atrial fibrillation patients was used. Results A total of 227 valid questionnaires were collected. Only 47.9% of doctors and 12.8% of nurses passed in knowledge, and 31.3% of doctors and 28.5% of nurses passed in behavior. Among them, risk factor assessment, preventive medication, stroke and bleeding risk assessment were the weakest. "Lack of departmental requirements" was identified as a common barrier to healthcare workers' adherence to guidelines. Job title and participation in training were common influencing factors that affected the knowledge and behavior of healthcare workers, and knowledge level was an important factor affecting healthcare worker behavior. Conclusion In order to improve the effect of CABG surgery and improve the quality of postoperative patient management, hospitals should further strengthen the knowledge and skills training of medical staff on the management guidelines of postoperative atrial fibrillation with CABG, formulate relevant systems to ensure the clinical implementation of guidelines.

Citation： LUO Lin, LIU Youhua, WANG Xinyu, LIU Guixin, TALXEN Yesbol, LIU Yisi. Current status of medical staff implementing the guidelines for atrial fibrillation after coronary artery bypass grafting: A multicenter cross-sectional study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(3): 377-384. doi: 10.7507/1007-4848.202306001 Copy

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2.	Liu Y, Wu F, Wu Y, et al. Mechanism of IL-6-related spontaneous atrial fibrillation after coronary artery grafting surgery: IL-6 knockout mouse study and human observation. Transl Res, 2021, 233: 16-31.
3.	Hindricks G , Potpara T , Dagres N , et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J, 2021, 42(5): 373-498.
4.	January CT , Wann LS , Calkins H , et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Circulation, 2019, 140(2): e125-e151.
5.	国家心血管病中心. 冠状动脉旁路移植术后心脏康复专家共识. 中国循环杂志, 2022, 35(1): 4-15.National Center for Cardiovascular Disease. Expert consensus on cardiac rehabilitation after coronary artery bypass grafting. Chin Circ J, 2022, 35(1): 4-15.
6.	Frendl G , Sodickson AC , Chung MK , et al. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg, 2014, 148(3): e153-e193.
7.	Muehlschlegel JD, Burrage PS, Ngai JY, et al. Society of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anaesthetists practice advisory for the management of perioperative atrial fibrillation in patients undergoing cardiac surgery. Anesth Analg, 2019, 128(1): 33-42.
8.	中国冠状动脉旁路移植术后二级预防专家共识组, 中国医师协会心血管医师分会冠心病外科学组, 中华医学会胸心血管外科学分会冠心病外科学组. 中国冠状动脉旁路移植术后二级预防专家共识(2020版). 中华胸心血管外科杂志, 2021, 37(4): 193-201.Working Group of the Chinese Expert Consensus on Secondary Prevention after Coronary Artery Bypass Surgery, The Task Force for Coronary Artery Disease of Chinese Association of Cardiovascular Surgeons(CACS), The Task Force for Coronary Artery Disease of Chinese Society of Thoracic and Cardiovascular Surgery(CSTCVS). Chinese expert consensus on secondary prevention after coronary artery bypass surgery (2020). Chin J Thorac Cardiovasc Surg, 2021, 37(4): 193-201.
9.	李维瑜, 刘静, 余桂林, 等. 知信行理论模式在护理工作中的应用现状与展望. 护理学杂志, 2015, 30(6): 107-110.Li WY, Liu J, Yu GL, et al. Application of the knowledge-belief-practice model in nursing practice: Current status and prospeets. J Nurs Sci, 2015, 30(6): 107-110.
10.	花文哲, 刘珊珊, 朱大乔. 理论域框架的发展及其应用进展. 护理研究: 下旬版, 2016, 30(6): 3.Hua WZ, Liu SS, Zhu DQ. Development and application progress on theoretical domains framework. Chin Nurs Res, 2016, 30(6): 3.
11.	Chen SY, Yen WJ, Lin YJ, et al. A Chinese version of the Caring Assessment Report Evaluation Q-sort scale for measuring patients' perception on nurses' caring behaviours: Reliability and validity assessment. Inter Jf Nurs Prac, 2012, 18(4): 388-395.
12.	Ferguson C, Inglis SC, Newton PJ, et al. Education and practice gaps on atrial fibrillation and anticoagulation: A survey of cardiovascular nurses. BMC Medical Education, 2016, 16(9): 1-10.
13.	Chang SS, Dong JZ, Ma CS, et al. Current status and time trends of oral anticoagulation use among chinese patients with nonvalvular atrial fibrillation: The Chinese Atrial Fibrillation Registry Study. Stroke, 2016, 47(7): 1803-1810.
14.	张亮, 周捷波, 吕莹, 等. 基于健康信念模型的医务人员职业暴露预防行为的调查研究. 华西医学, 2023, 38(3): 392-397.Zhang L, Zhou JB, Lv Y, et al. Investigation on preventive behaviors of occupational exposure in medical staff based on health belief model. West China Med J, 2023, 38(3): 392-397.
15.	叶雅雯, 王丽姿. 护士参与心房颤动患者抗凝管理模式的研究现状. 中国实用护理杂志, 2017, 33(15): 5.Ye YW, Wang LZ. Nurses' participation in the management of anticoagulation among patients with atrial fibrillation: A literature review. Chin J Prac Nurs, 2017, 33(15): 5.
16.	Valente TW, Paredes P, Poppe PR. Matching the message to the process the relative ordering of knowledge, attitudes, and practices in behavior change research. Hum Commun Res, 1998, 24(3): 366-385.
17.	陈耀龙, 史乾灵, 赵俊强, 等. 从知到行: 跨越指南理论与实践的鸿沟. 协和医学杂志, 2020, 11(6): 746-753.Chen YL, Shi QL, Zhao JQ, et al. From knowledge to action: Bridging the gap between theory and practice in clinical practice guidelines. Med J Peking Union Med Coll Hosp, 2020, 11(6): 746-753.
18.	Pronovost PJ. Enhancing physicians' use of clinical guidelines. JAMA, 2013, 310(23): 2501-2502.
19.	晏蓉, 李素云, 刘云访. 210名外科护士循证护理能力现状及影响因素分析. 护理学报, 2019, 26(6): 47-50.Yan R, Li SY, Liu YF. Evidence-based nursing ability of surgical nurses and its influence factors: A 210-case study. J Nurs, 2019, 26(6): 47-50.
20.	马艳秋, 沈悦好, 武蕊, 等. 基于理论域框架的ICU护士执行身体约束缩减行动障碍因素的质性研究. 天津护理, 2022, 30(6): 5.Ma YQ, Shen YH, Wu R, et al. Barriers of ICU nurses perform physical restraint minimization actions:a qualitative study based on theoretical domains framework. Tianjin J Nurs, 2022, 30(6): 5.
21.	Nilsson K, Brulin C, Grankvist K, et al. Senior nursing students' reflections on deviations from guideline adherence regarding venous blood specimen collection practice: A qualitative study. Nurse Educ Today, 2022, 115: 105375.
22.	张静, 梁士楚, 陈忠兰. 护理领域中临床实践指南依从性的研究进展. 中华护理杂志, 2023, 58(6): 758-763.Zhang J, Liang SC, Chen ZL. The adherence of clinical practice guidelines in nursing fields: Where things stand. Chin J Nurs, 2023, 58(6): 758-763.
23.	杨莉, 叶红芳, 孙倩倩. 临床护士循证护理能力现状及影响因素分析. 护士进修杂志, 2023, 38(2): 108-113.Yang L, Ye HF, Sun QQ. Current status of evidence-based nursing ability in clinical nurses and its influencing factors. J Nurs Train, 2023, 38(2): 108-113.
24.	周颖, 王加谋, 田晓勤, 等. 护士职业认同的研究进展. 鄂州大学学报, 2022, 29(4): 109-112.Zhou Y, Wang JM, Tian XQ, et al. Research progress on nurses' professional identity. J Ezhou Univ, 2022, 29(4): 109-112.
25.	喻佳洁, 李琰, 陈雯雯, 等. 从循证医学到循证科学的必然趋势. 中国循证医学杂志, 2019, 19(1): 119-124.Yu JJ, Li Y, Chen WW, et al. The inevitable tendency from evidence-based medicine to evidence-based science. Chin J Evidence-Based Med, 2019, 19(1): 119-124.

1. 蒋子薇, 赵海波, 刘溢思. 心脏术后纤维蛋白原和胶原代谢的变化规律及其与术后心房颤动关系的前瞻性队列研究. 中国胸心血管外科临床杂志, 2022, 29(3): 335-345.Jiang ZW, Zhao HB, Liu YS. Changes of fibrinogen and collagen metabolism after cardiac surgery and their relationship with postoperative atrial fibrillation: A prospective cohort study. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(3): 335-345.
2. Liu Y, Wu F, Wu Y, et al. Mechanism of IL-6-related spontaneous atrial fibrillation after coronary artery grafting surgery: IL-6 knockout mouse study and human observation. Transl Res, 2021, 233: 16-31.
3. Hindricks G , Potpara T , Dagres N , et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J, 2021, 42(5): 373-498.
4. January CT , Wann LS , Calkins H , et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Circulation, 2019, 140(2): e125-e151.
5. 国家心血管病中心. 冠状动脉旁路移植术后心脏康复专家共识. 中国循环杂志, 2022, 35(1): 4-15.National Center for Cardiovascular Disease. Expert consensus on cardiac rehabilitation after coronary artery bypass grafting. Chin Circ J, 2022, 35(1): 4-15.
6. Frendl G , Sodickson AC , Chung MK , et al. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg, 2014, 148(3): e153-e193.
7. Muehlschlegel JD, Burrage PS, Ngai JY, et al. Society of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anaesthetists practice advisory for the management of perioperative atrial fibrillation in patients undergoing cardiac surgery. Anesth Analg, 2019, 128(1): 33-42.
8. 中国冠状动脉旁路移植术后二级预防专家共识组, 中国医师协会心血管医师分会冠心病外科学组, 中华医学会胸心血管外科学分会冠心病外科学组. 中国冠状动脉旁路移植术后二级预防专家共识(2020版). 中华胸心血管外科杂志, 2021, 37(4): 193-201.Working Group of the Chinese Expert Consensus on Secondary Prevention after Coronary Artery Bypass Surgery, The Task Force for Coronary Artery Disease of Chinese Association of Cardiovascular Surgeons(CACS), The Task Force for Coronary Artery Disease of Chinese Society of Thoracic and Cardiovascular Surgery(CSTCVS). Chinese expert consensus on secondary prevention after coronary artery bypass surgery (2020). Chin J Thorac Cardiovasc Surg, 2021, 37(4): 193-201.
9. 李维瑜, 刘静, 余桂林, 等. 知信行理论模式在护理工作中的应用现状与展望. 护理学杂志, 2015, 30(6): 107-110.Li WY, Liu J, Yu GL, et al. Application of the knowledge-belief-practice model in nursing practice: Current status and prospeets. J Nurs Sci, 2015, 30(6): 107-110.
10. 花文哲, 刘珊珊, 朱大乔. 理论域框架的发展及其应用进展. 护理研究: 下旬版, 2016, 30(6): 3.Hua WZ, Liu SS, Zhu DQ. Development and application progress on theoretical domains framework. Chin Nurs Res, 2016, 30(6): 3.
11. Chen SY, Yen WJ, Lin YJ, et al. A Chinese version of the Caring Assessment Report Evaluation Q-sort scale for measuring patients' perception on nurses' caring behaviours: Reliability and validity assessment. Inter Jf Nurs Prac, 2012, 18(4): 388-395.
12. Ferguson C, Inglis SC, Newton PJ, et al. Education and practice gaps on atrial fibrillation and anticoagulation: A survey of cardiovascular nurses. BMC Medical Education, 2016, 16(9): 1-10.
13. Chang SS, Dong JZ, Ma CS, et al. Current status and time trends of oral anticoagulation use among chinese patients with nonvalvular atrial fibrillation: The Chinese Atrial Fibrillation Registry Study. Stroke, 2016, 47(7): 1803-1810.
14. 张亮, 周捷波, 吕莹, 等. 基于健康信念模型的医务人员职业暴露预防行为的调查研究. 华西医学, 2023, 38(3): 392-397.Zhang L, Zhou JB, Lv Y, et al. Investigation on preventive behaviors of occupational exposure in medical staff based on health belief model. West China Med J, 2023, 38(3): 392-397.
15. 叶雅雯, 王丽姿. 护士参与心房颤动患者抗凝管理模式的研究现状. 中国实用护理杂志, 2017, 33(15): 5.Ye YW, Wang LZ. Nurses' participation in the management of anticoagulation among patients with atrial fibrillation: A literature review. Chin J Prac Nurs, 2017, 33(15): 5.
16. Valente TW, Paredes P, Poppe PR. Matching the message to the process the relative ordering of knowledge, attitudes, and practices in behavior change research. Hum Commun Res, 1998, 24(3): 366-385.
17. 陈耀龙, 史乾灵, 赵俊强, 等. 从知到行: 跨越指南理论与实践的鸿沟. 协和医学杂志, 2020, 11(6): 746-753.Chen YL, Shi QL, Zhao JQ, et al. From knowledge to action: Bridging the gap between theory and practice in clinical practice guidelines. Med J Peking Union Med Coll Hosp, 2020, 11(6): 746-753.
18. Pronovost PJ. Enhancing physicians' use of clinical guidelines. JAMA, 2013, 310(23): 2501-2502.
19. 晏蓉, 李素云, 刘云访. 210名外科护士循证护理能力现状及影响因素分析. 护理学报, 2019, 26(6): 47-50.Yan R, Li SY, Liu YF. Evidence-based nursing ability of surgical nurses and its influence factors: A 210-case study. J Nurs, 2019, 26(6): 47-50.
20. 马艳秋, 沈悦好, 武蕊, 等. 基于理论域框架的ICU护士执行身体约束缩减行动障碍因素的质性研究. 天津护理, 2022, 30(6): 5.Ma YQ, Shen YH, Wu R, et al. Barriers of ICU nurses perform physical restraint minimization actions:a qualitative study based on theoretical domains framework. Tianjin J Nurs, 2022, 30(6): 5.
21. Nilsson K, Brulin C, Grankvist K, et al. Senior nursing students' reflections on deviations from guideline adherence regarding venous blood specimen collection practice: A qualitative study. Nurse Educ Today, 2022, 115: 105375.
22. 张静, 梁士楚, 陈忠兰. 护理领域中临床实践指南依从性的研究进展. 中华护理杂志, 2023, 58(6): 758-763.Zhang J, Liang SC, Chen ZL. The adherence of clinical practice guidelines in nursing fields: Where things stand. Chin J Nurs, 2023, 58(6): 758-763.
23. 杨莉, 叶红芳, 孙倩倩. 临床护士循证护理能力现状及影响因素分析. 护士进修杂志, 2023, 38(2): 108-113.Yang L, Ye HF, Sun QQ. Current status of evidence-based nursing ability in clinical nurses and its influencing factors. J Nurs Train, 2023, 38(2): 108-113.
24. 周颖, 王加谋, 田晓勤, 等. 护士职业认同的研究进展. 鄂州大学学报, 2022, 29(4): 109-112.Zhou Y, Wang JM, Tian XQ, et al. Research progress on nurses' professional identity. J Ezhou Univ, 2022, 29(4): 109-112.
25. 喻佳洁, 李琰, 陈雯雯, 等. 从循证医学到循证科学的必然趋势. 中国循证医学杂志, 2019, 19(1): 119-124.Yu JJ, Li Y, Chen WW, et al. The inevitable tendency from evidence-based medicine to evidence-based science. Chin J Evidence-Based Med, 2019, 19(1): 119-124.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Current status of medical staff implementing the guidelines for atrial fibrillation after coronary artery bypass grafting: A multicenter cross-sectional study

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